Endoscopic removal technique of migrated pancreatic plastic stents

Abstract

Endoscopic pancreatic stenting (EPS) is used for various pancreatic conditions. With the increasing use of pancreatic stents, many complications have been observed. Especially, proximal stent migration presents a more serious condition because of the possibility of pancreatic duct (PD) damage. However, the removal of proximally migrated stents is technically challenging because of the small PD diameter, the bended PD course, the presence of PD strictures, and the lack of suitable devices for stent removal. Thus, few cases of surgical intervention have been encountered. In this study, we review the endoscopic treatment of proximally migrated pancreatic plastic stents. We classify migrated stent conditions into four types according to stent and PD conditions. In Type A, the main pancreatic duct (MPD) has no stricture. In Type B, the stent is positioned across the stricture on the MPD. In Type C, the stent is positioned further away from the stricture on the MPD. The tip of the proximal stent is located in the MPD in types A thru C. In Type D, the tip of the proximal stent is located in a branch duct. We introduced the strategy of endoscopic removal technique of each type of migrated plastic stents.

Endoscopic retrieval of two proximally migrated plastic pancreatic duct stents

“…3 Proximal PD stent migration is more commonly associated with sphincter of Oddi dysfunction, straight stents, flaps on the distal portion of stent, and longer stents. 1,2 While the distal stent migration into the duodenum is rarely of any clinical consequence as the stent is excreted uneventfully, proximal stent migration further into the PD results in obstructive pancreatitis.…”

Endoscopic treatment of intraductal pancreatic stent fragmentation

“…[14][15][16] Baron et al also described the retrieval of a migrated stent with the use of tools that are used in interventional cardiology. In the literature, there are four studies concerning the treatment of proximal stent migration that were conducted on large groups of patients 9,14,15,18 (Table 5). 9,14,15 In the present study, fragments of broken stents were removed endoscopically in 93.94% (31/33) of patients with complications noted in 12.12% (4/33) of patients.…”

“…[1][2][3][4][5] Complications of endoscopic treatment are reported more and more often as a result of popularization of pancreatic endotherapy. 9 Proximal pancreatic stent migration (into the duct) and its fragmentation are serious clinical problems because of the high risk of pancreatic duct injury. 7,8 Distal stent migration (out of the pancreatic duct) is less harmful.…”

“…6 Stent fracture and migration of the stent proximally (upstream) or distally (downstream) are rare complications of pancreatic endotherapy. 7,9 Proximally migrated or fragmented stent not only loses its function, but also causes pancreatic duct obstruction that may lead to acute pancreatitis. Apart from the loss of stent function it causes no serious consequences and a stent is usually excreted spontaneously with stool.…”

“…Apart from the loss of stent function it causes no serious consequences and a stent is usually excreted spontaneously with stool. 9 Proximal pancreatic stent migration (into the duct) and its fragmentation are serious clinical problems because of the high risk of pancreatic duct injury. 7,9 Proximally migrated or fragmented stent not only loses its function, but also causes pancreatic duct obstruction that may lead to acute pancreatitis.…”