Suture-loop anchoring at the distal end of a pancreatic stent: a novel approach to prevent proximal migration

Proximal migration of pancreatic stents, though rare (0.2%) [1], remains a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) that requires complex retrieval methods including endoscopic grasping, pancreatoscopy, or surgery [2]. Recent advances include endoscopic ultrasound (EUS)-guided retrieval [3], yet these approaches demand expertise and resources.

We propose an innovative preventive strategy. An absorbable suture is threaded through the terminal side hole, and the length of the suture after knotting is kept at approximately 3 cm ([Fig. 1] a). The video documents a 78-year-old jaundiced patient in whom a trainee inadvertently deployed a 5-Fr stent deeply into the pancreatic duct ([Fig. 1] b). The supervising physician grasped the externalized suture with rat tooth forceps ([Fig. 1] c, [Video 1]), successfully repositioning the stent ([Fig. 1] d) and enabling subsequent biliary stenting. This suture-loop technique provides a simple yet reliable solution for preventing pancreatic stent migration. The technique is particularly suitable for trainees and is recommended for widespread clinical adoption.

Fig. 1 Novel suture-loop anchoring at the distal pancreatic stent: Technique demonstration and migration rescue. a Suture-loop anchoring technique: An absorbable suture is threaded through the distal side hole of the pancreatic stent, with the knotted suture length maintained at 3 cm. b Deep migration of a 5-Fr pancreatic stent during trainee-led deployment in a jaundiced patient. c Retrieval of the migrated stent via the externalized suture-loop using a rat tooth forceps. d Repositioned pancreatic stent enabling subsequent biliary intervention.

Demonstration of suture-loop technique for pancreatic stent fixation via externalized suture retrieval, enabling migration rescue.Video 1

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• References

• 1 Cai YL, Wang F, Zhang J. et al. Incidence, risk factors and endoscopic retrieval of proximally migrated pancreatic stents: 25 years of experience in a high-volume center – a case controlled study. Int J Surg 2025; 111: 3115-3119
• 2 Jayanna SH, Bush N, Sharma R. et al. Endoscopic removal of proximally migrated pancreatic duct stents: a case series and literature review. Ann Gastroenterol 2025; 38: 230-236
• 3 Akiyama S, Tanke G, Inokuma T. Successful retrieval of a migrated pancreatic stent via endoscopic ultrasound-guided transluminal drainage using an ultraslim upper endoscope. Dig Endosc 2025;