Use of intraductal cholangioscopy devices to retrieve migrated pancreatic stents

The incidence of proximal pancreatic stent migration is unknown, though early studies report up to 5 %, with recently reported success rates of < 80 % for stent retrieval using conventional techniques [1]. Stent retrieval remains challenging owing to characteristically small pancreatic duct diameters, strictures, tortuous distal pancreatic duct course, stent location proximal to the genu, and small-caliber stents.

Novel retrieval techniques for proximally migrated pancreatic stents have included pancreatoscopy to achieve guidewire cannulation of the stent lumen [2] [3] or facilitate retrieval using SpyByte forceps (Boston Scientific, Marlborough, Massachusetts, USA), though duct diameter must be large enough to accommodate a SpyScope for such techniques. For ducts of small or normal diameter, proximally migrated stents can be cannulated with a guidewire, over which mini-snares can be passed to retrieve the stent [4] [5].

We describe two cases in which a SpySnare and SpyBasket, used without the accompanying SpyScope, were used to retrieve proximally migrated pancreatic stents in normal diameter ducts ([Video 1]).

Video 1 Use of SpyScope devices to retrieve migrated pancreatic stents.

A 52-year-old woman was referred for retrieval of a proximally migrated prophylactic 5-Fr pancreatic stent. On pancreatography the stent’s distal tip was proximal to the genu with the proximal tip in the body or tail. A pancreatic sphincterotomy was performed using a papillotome over a guidewire. The stent lumen was cannulated with a 0.035-inch guidewire, over which a SpySnare was advanced to capture and retrieve the stent.

A 44-year-old woman with history of relapsing pancreatitis presented for repeat endotherapy. The previously placed pancreatic stent was not visible endoscopically, and stent migration proximal to the genu was confirmed on fluoroscopy. A 4-mm balloon was used to dilate a distal pancreatic duct stricture. The stent lumen was cannulated with a curved 0.035-inch guidewire. Despite previous unsuccessful retrieval attempts using SpySnare, the pancreatic stent was successfully captured and retrieved using SpyBasket.

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• References

• 1 Price LH, Brandabur JJ, Kozarek RA. et al. Good stents gone bad: endoscopic treatment of proximally migrated pancreatic duct stents. Gastrointest Endosc 2009; 70: 174-179
• 2 Yao W, Huang Y, Chang H. et al. Endoscopic retrieval of a migrated pancreatic stent under direct pancreatoscopy by use of a “snare over in-stent wire guide” method. VideoGIE 2018; 3: 272-274
• 3 Girotra M, Raghavapuram S, Tharian B. Successful removal of deeply migrated pancreatic stent using biliary dilation balloon and the new single-operator digital cholangioscope. Gastrointest Endosc 2016; 84: 1061-1062
• 4 Yoon LY, Moon JH, Choi HJ. et al. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents after endoscopic papillectomy for ampullary adenoma. Gut Liver 2011; 5: 532-535
• 5 Liao YS, Zhao Q, Fan Y. et al. Proximal migration of a 5 French pancreatic stent during bile stone extraction: a successful retrieval using mini-snare. Niger J Clin Pract 2014; 17: 384-386