Introduction: Biliary prosthesis implant by endoscopic-retrograde-cholangiopancreatography (ERCP) is alternative treatment for obstructive biliary tree diseases. Plastic prosthesis have four-to-six months average patency and metallic ones eight-to-twelve, and the withdrawal should be evaluated in this timeframe. After implantation, follow-up is necessary. Early complications detection allows surgeon to act and prevent prosthesis occlusion or movement, pancreatitis or cholecystitis, avoiding fatal outcomes such as cholangitis and secondary biliary cirrhosis.

Case report: 76-year-old-female underwent videolaparoscopy cholecystectomy ten years ago. Four years ago choledocholithiasis was diagnosed. A metal biliary prosthesis was implanted after ERCP due to the impossibility of calculus extraction. Since then, patient remained asymptomatic. However, after yearly-follow-up bile duct MRI, choledochus diameter increase of 2.0 to 2.5cm was observed with an increased gamma-glutamyltransferase (?-GT). Videolaparoscopic prosthesis removal was proceeded with biliodigestive anastomosis. During surgery, after choledochotomy of dilated choledochus, the prosthesis was identified obstructed by thick biliary contents and small calculus. After unsuccessful detachment attempts, dense epithelial tissue adhered in its metal web was found, and its section was performed, remaining the distal segment within the papilla. Next, choledochoduodenostomy was performed successfully.

Conclusion: Despite the improve that biliary prosthesis has brought to biliary obstruction arsenal, a surgeon must consider its inherent complications. In this case report, the prosthesis overtime associated with 25% increase in choledochal diameter and increase of ?-GT was decisive at removing the prosthesis. During surgery, the removal shown itself mandatory, since it was obstructed and strongly adhered to the papilla. At last, biliodigestive anastomosis was necessary, avoiding eventual severe complications.