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.
Endoscopy_UCTN_Code_CPL_1AK_2AG
