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Endoscopy 2020; 52(10): E359
DOI: 10.1055/a-1122-8051
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Peroral pancreatoscopy-assisted removal of internally migrated fractured pancreatic stent

Shujaath Asif
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
Rakesh Kalpala
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
,
D. Nageshwar Reddy
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Endoscopic removal of internally migrated pancreatic stents is sometimes challenging even in the hands of expert endoscopists, because of the high risk of pancreatitis, pancreatic ductal leak, and perforation. Often multiple sessions are required to achieve successful retrieval. Peroral pancreatoscopy (POPS) for direct visualization of the main pancreatic duct was initially described in 1976 by Kawai et al. [1]. Pancreatoscopy is used for visualization and histological diagnosis of intraductal papillary mucinous neoplasms [2] [3], and also to delineate pancreatic duct strictures and to differentiate between benign and malignant disease. It is also used for lithotripsy of pancreatic ductal stones [3] [4].

We report the case of a 9-year-old female patient with chronic pancreatitis. She had undergone pancreatic ductal stenting elsewhere, and presented to us with pancreatic pain. Endoscopic retrograde cholangiopancreatography (ERCP) showed a fractured and internally migrated pancreatic stent. The migrated stent fragments were removed in multiple sessions with the assistance of peroral pancreatoscopy. The proximal fragment of the stent was removed using foreign-body forceps and the distal fragment was removed using a retrieval snare and retrieval basket.

Video 1 Removal of a fractured and internally migrated pancreatic stent by peroral pancreatoscopy.


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Publication History

Article published online:
27 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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