Endoscopic management of internally migrated pancreatic duct stents (with video)

Endotherapy for the Proximal Migration of Pancreatic Stents: A Systematic Review

OBJECTIVES

Proximal migration is one of the complications after pancreatic duct stenting. This study aimed to determine the incidence of proximal migration and to analyze the rescue methods.

MATERIALS AND METHODS

A search was performed in MEDLINE/Embase database. The literatures included were reviewed and analyzed. Retrieval tools were classified into the following 3 classes: class A works by indirectly contacting the outer surface of the stent. Class B works by directly contacting the outer surface. Class C works by directly contacting the inner surface.

RESULTS

416 literatures were retrieved from 1983 to 2021. 15 literatures were included. The incidence of proximal migration of pancreatic stents was 4.7% (106/2246). The success rate of endotherapy was 86.6% (214/247), and the surgical conversion rate of it was 9.3%. Among the 214 cases in which the displaced stents were successfully removed under endoscopy, 49 cases (22.9%) used class A methods, 154 cases (72.0%) used class B methods, and 11 cases (5.1%) used class C methods. The overall rate of postoperative complication was 12.1%, including postprocedure pancreatitis (9.1%, 18/247), followed by bleeding (1.5%), perforation (1.0%), and biliary infection (0.5%).

CONCLUSIONS

Endoscopy is an effective method for the treatment of proximal displacement of pancreatic stents with acceptable complication rate.

SpyGlass DS system-assisted retrieval of proximally migrated pancreatic duct stent in a patient with chronic pancreatitis

Pancreatic duct (PD) stent migration is among the recognized complications of endoscopic retrograde cholangiopancreatography (ERCP) with PD stent placement. Proximal stent migration poses a challenge for removal due to risks of PD damage, smaller caliber, and possible stricture. Here, we present a case of SpyGlass DS system-assisted PD stent repositioning after failure with traditional tools.

Successful endoscopic retrieval of a proximally migrated pancreatic stent in a patient with pancreaticojejunal anastomotic stenosis

Objective: We report a case of successful endoscopic retrieval of a proximal (upstream) migrated pancreatic stent through a pancreaticojejunal anastomosis. Patient: A 71-year-old man with a history of pancreatoduodenectomy with modified Child's reconstruction and concomitant internal pancreatic ductal stenting for cholangiocarcinoma 41 months before presentation, was referred to our department for the treatment of acute pancreatitis. Endoscopic stent retrieval was performed using a short-type single-balloon enteroscope with a transparent hood. A pancreaticojejunal anastomosis was identified as a pinhole-like opening buried within the intestinal folds and dilated using a balloon catheter. Finally, the migrated pancreatic stent was successfully retrieved using a wire-guided basket catheter, without complications. Conclusion: Endoscopic retrieval of a proximally migrated pancreatic stent after pancreatoduodenectomy should be attempted, even in cases of stenotic pancreaticojejunal anastomosis, to avoid highly invasive procedures, including surgery.

Incidence, Risk Factors, and Treatment of Proximally Migrated Pancreatic Stents

AIM

The aim of this study was to investigate the incidence, risk factors, and treatment strategies of proximally migrated pancreatic stents.

MATERIALS AND METHODS

The data of 626 sessions of 421 patients with pancreatic duct stenting were retrospectively analyzed between 2010 and 2018, and patients with proximally migrated stents were included in the study.

RESULTS

Of 626 stents examined, 77 migrated proximally (12%). The migration rate (MR) was 16%, 2%, and 7%, respectively, in patients treated with chronic pancreatitis, malignancy, and pancreatic leakage indication. The MR was 14% in procedures with pancreatic duct stenosis, 21% in procedures with pancreatic sphincterotomy, and 27% in procedures performed from minor papillae. The MR of the 5, 7, and 10 Fr stents was 4%, 17%, and 10%, respectively. Of the 77 migrated stents, 64 were successfully removed (83%). This success rate (SR) was 84% in procedures with chronic pancreatitis indication, 83% in procedures with pancreatic duct stenosis, 79% in procedures with sphincterotomy, and 75% in procedures performed from minor papillae. The SR of the 5, 7, and 10 Fr stents was 100%, 79%, and 92%, respectively. It was also determined that 33 stents were fractured and migrated (43%). The SR of the fractured stents was 76%. Moreover, of the stents that were successfully removed, 35 were removed with forceps (55%) and 15 (23%) were removed with a balloon. Furthermore, in 47 cases, the stent was removed in the first session (73%). Acute pancreatitis occurred in 5 patients (8%) and perforation occurred in 1 patient (2%).

CONCLUSION

In this study, it was shown that proximal migration of pancreatic stents is frequent and most of these stents can be removed successfully.

Endoscopic retrieval of two proximally migrated plastic pancreatic duct stents

Plastic stent migration is an important complication of pancreatic duct (PD) stenting, with distal (downstream) migration being more common than proximal (upstream) migration. While the distal stent migration into the duodenum is rarely of any clinical consequence, proximal stent migration can cause serious complications, including obstructive pancreatitis. The endoscopic removal of proximally migrated stents is difficult because of the small diameter of PD, the bended and sometimes tortuous course of PD, the presence of strictures, and a lack of dedicated endoscopic accessories. We report a rare case of endoscopic retrieval of two proximally migrated plastic stents from PD.