Recanalization using a novel drill-shaped dilator for a severe pancreatic duct stricture and impacted pancreatic duct stone

Pancreatic duct stones can cause severe acute pancreatitis and are sometimes fatal. Endoscopic pancreatic duct drainage has been established as a first-line treatment [1] [2]; however, hard stones can make passing through strictures challenging. A Soehendra stent retriever with a screw tip (SSR-7; Cook Medical, Tokyo, Japan) may be useful in this situation [3], but a serious complication can occur should the tip of the stent retriever detach and migrate into the pancreatic duct [4]. A novel dilator with a unique shape was recently developed (Tornus ES for 0.025-inch guidewire; 7 Fr, stainless steel; Asahi Intecc, Aichi, Japan) [5] ([Fig. 1]). This drill-shaped dilator can be rotated to break through strictures. Here, we describe recanalization using this novel drill-shaped dilator for a patient with severe pancreatic duct stricture and an impacted pancreatic duct stone ([Video 1]).

Fig. 1 Photograph of the novel drill-shaped dilator that can be advanced by rotation of the handle.

Video 1 Recanalization using a novel drill-shaped dilator in a patient with a severe pancreatic duct stricture and an impacted pancreatic duct stone.

A 49-year-old man with acute pancreatitis due to a pancreatic duct stone was admitted to our hospital. Computed tomography scans showed an impacted pancreatic duct stone in the pancreatic head with dilatation of the caudal pancreatic duct ([Fig. 2]). We performed pancreatic duct drainage via the papilla. Although the caudal pancreatic duct could not be visualized on pancreatography because of the impacted stone, a guidewire was advanced across the stone into the dilated caudal pancreatic duct ([Fig. 3]). Despite the use of various dilation devices, it was difficult to break through the stricture. With clockwise rotation, the novel drill-shaped dilator could however be passed through the stricture, while chipping away at the stone, without requiring a strong pushing force ([Fig. 4]). A 5-Fr plastic stent was then successfully placed beyond the pancreatic duct stone ([Fig. 5]). There were no adverse events and the patient was subsequently discharged.

Fig. 2 Computed tomography scans showing pancreatitis due to an impacted pancreatic duct stone in the head of the pancreas

Fig. 3 Radiographic images taken during endoscopic retrograde pancreatography showing: a a large pancreatic duct stone in the pancreatic head (yellow arrow); b, c a guidewire advanced into the dilated caudal pancreatic duct, although attempts to pass various dilators through the pancreatic duct stone failed.

Fig. 4 Fluoroscopic images (inset endoscopic images) showing the drill dilator being successfully passed through the impacted pancreatic duct stone.

Fig. 5 Fluoroscopic images showing successful placement of a 5-Fr plastic stent beyond the pancreatic duct stone.

This novel drill-shaped dilator may be safe and effective for severe pancreatic duct strictures, and provides an innovative device for recanalization.

Endoscopy_UCTN_Code_TTT_1AR_2AG

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Deviere J. Pancreatic stents. Gastrointest Endosc Clin N Am 2011; 21: 499-510
• 2 Adler DG, Lichtenstein D, Baron TH. et al. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc 2006; 63: 933-937
• 3 Ogura T, Kamiyama R, Yamada M. et al. Recanalization method for pancreatic duct stricture complicated by a huge pancreatic stone. Endoscopy 2018; 50: E250-E251
• 4 Ogura T, Okuda A, Miyano A. et al. Successful digital cholangioscopy removal of a stent-retriever tip migrated into the periphery of the bile duct. Endoscopy 2018; 50: E113-E114
• 5 Yamada M, Hara K, Haba S. et al. Endoscopic ultrasound-guided hepaticogastrostomy using a novel drill dilator. Endoscopy 2022;

Publikationsverlauf

Artikel online veröffentlicht:
16. Januar 2023