Successful removal of a migrated stent retriever tip using wire-guided forceps

Stent retriever dilation (Soehendra stent retriever, SSR-7; Cook, Tokyo, Japan) has demonstrated effectiveness in treating main pancreatic duct stenosis in chronic pancreatitis [1] [2]. However, there have been few reports on stent retriever tip breakage [3]. In this study, we describe a case of dislodgment of the stent retriever tip during main pancreatic duct stenosis owing to chronic pancreatitis, including the removal method.

A 56-year-old man was referred to our hospital for obstructive pancreatitis because of chronic pancreatitis-associated pancreatic stones. Initial endoscopic retrograde cholangiopancreatography (ERCP) demonstrated stenosis of the main pancreatic duct in the pancreatic body. A 5-Fr pancreatic stent was placed in the pancreatic head because it failed to pass through the body stenosis. Subsequently, contrast-enhanced abdominal computed tomography (CT) demonstrated persistent inflammation around the pancreatic body and tail ([Fig. 1]). Another ERCP was performed to place a pancreatic stent for body stenosis. Pancreatography demonstrated pancreatic body stenosis and extrapancreatic leakage of contrast agent at the stenosis site. Initially, the stenosis was partially dilated using a thin-tipped balloon catheter. Further caudal dilation was attempted; however, the catheter and another bougie dilator failed to pass through the stenosis. Subsequently, we dilated the stenosis using the SSR-7. When the SSR-7 was removed following dilatation, the tip was dislodged midway through the stenosis and remained in the pancreatic duct ([Video 1]). An attempt to remove the tip using biopsy forceps failed because it could not pass through the stenosis. Subsequently, a wire-guided single-opening biopsy forceps (E634044, 2.2-mm channel; Olympus, Tokyo, Japan) was used to successfully grasp and remove the dislodged tip through the stenosis ([Fig. 2]). The stenosis was dilated again using a thin-tipped balloon catheter, followed by the successful placement of a 5-Fr pancreatic stent at the stenosis site.

Fig. 1 Abdominal computed tomography (CT) demonstrates pancreatic stones in the pancreatic body (left). The arterial phase of contrast-enhanced CT demonstrates pancreatic stones with dilation of the main pancreatic duct and inflammation around the pancreas (right).

Fig. 2 The Soehendra stent retriever tip is dislodged.

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A wire-guided single-opening biopsy forceps successfully grasped the dislodged tip through the stenosis.Video 1

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• References

• 1 Brand B, Thonke F, Obytz S. et al. Stent retriever for dilation of pancreatic and bile duct strictures. Endoscopy 1999; 31: 142-145
• 2 Kaul V, Geenen JE, Catalano MF. Soehendra stent retriever (SSR) for dilation of pancreatic and biliary strictures. Gastrointest Endosc 2007; 65: AB212
• 3 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