SUCCESFUL RETRIEVAL OF A PROXIMALLY MIGRATED PANCREATIC STENT BY DIGITAL PANCREATOSCOPY

With the increasing use of pancreatic duct stenting, its complications have also been recognized. Proximal stent migration has been described in 5.2% of patients and it represents a challenging situation. Although there is no consensus for the best strategy for retrieval, several endoscopic techniques have been described. These techniques have a success rate of 87%, but not infrequently distal pancreatectomy is needed. More recently, the use of digital pancreatoscopy for this matter has been described.

We present 45 year-old male patient, with a bile leak after laparoscopic cholecystectomy. An ERCP was performed and a biliary stent was placed to manage the bile leak. The procedure was complicated by a proximally migrated pancreatic stent placed to assist cannulation. After multiple failed removal attempts, a prophylactic stent for prevention of pancreatitis was placed and a decision for surgical retrieval by distal pancreatectomy was taken. During open surgery, the surgeon found “changes of acute pancreatitis”, decided to abort the procedure and placed a retroperitoneal drain. The patient was referred to our unit for another attempt of retrieval.

After two failed attempts using a biliary extraction balloon and an over the wire forceps, we decided to use digital pancreatoscopy, with which successful retrieval using a slim scope biopsy forceps was achieved. Afterwards, during a control pancreatography, a pancreatic leak was revealed, so a second digital pancreatoscopy was undertaken where we visualized the site of impaction of the PS and the previously located retroperitoneal drain. We decided to manage the leak with a new PS, without further complications. Patient evolved well and was discharge without the retroperitoneal drain 10 days after the procedure.

In this case we successfully retrieved a proximally migrated PS by digital pancreatoscopy and through the slim scope biopsy forceps. This way further complications and need for surgery were avoided.