Proximal (upstream) migration of pancreatic duct stents is a
recognized complication that occurs in up to 5.2 % of patients
[1], and stent retrieval is important to prevent
long-term serious ductal damage. Reported techniques to remove proximally
migrated pancreatic duct stents include balloon extraction, direct snare or
forceps grasp, and wire cannulation with snare capture. We report a novel
technique using the SpyGlass Direct Visualization System (Boston Scientific,
Natick, Massachusetts, USA).
A 50-year-old woman with chronic pancreatitis underwent pancreatic
endotherapy for pancreatic ductal stones. Pancreatic major papilla
sphincterotomy and balloon sweeps of the pancreatic duct were carried out. At
the end of the procedure, a 7-Fr plastic Teflon-coated, 7-cm long, straight
pancreatic duct stent was inserted for free drainage of pancreatic juice. After
3 months, the stent was noted to have migrated proximally, reaching the tail of
the pancreas ([Fig. 1]).
Fig. 1 Deeply migrated
pancreatic duct stent.
Attempts to retrieve the stent using balloon, snares, and forceps
were unsuccessful. Guide wire cannulation of the stent under fluoroscopy alone
was also unsuccessful. Using SpyGlass pancreatoscopy, we were able to visualize
the distal end of the stent ([Fig. 2]).
Fig. 2 Distal end of the stent
visualized with SpyGlass pancreatoscopy.
The Spyscope’s (Boston Scientific, Natick, Massachusetts, USA)
four-way deflected steering capability provided improved maneuverability to
successfully cannulate the stent with a 0.032-inch Terumo guide wire ([Fig. 3]),
inserted via the Spyscope’s accessory channel.
Fig. 3 Stent cannulated with
0.032-inch guide wire.
The Spyscope was then removed and a 7-Fr Soehendra Stent Retriever
(Wilson-Cook, Winston-Salem, North Carolina, USA) was used in an over-the-wire
fashion to remove the stent completely ([Fig. 4]).
Fig. 4 Stent removed with a
Soehendra Stent Retriever.
There has only been one previous report on the use of SpyGlass
pancreatoscopy to remove migrated pancreatic duct stents [2]. In that report, a 5-Fr stent was removed successfully
using SpyBite (Boston Scientific, Natick, Massachusetts, USA) forceps. In our
case, stent retrieval with SpyBite forceps failed as it was unable to provide a
secure grasp of the larger 7-Fr stent. SpyGlass pancreatoscopy facilitates
successful guide wire cannulation of migrated stents, which can then be removed
with a Soehendra Stent Retriever.
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