Retrieval of migrated pancreatic stent: "stent-in-stent" technique.

A13-year-old boy, inwhoma10-Fr, 10-cm pancreatic stent hadbeenplaced3months earlier tomanage chronic pancreatitis and pain syndrome, was admitted for stent exchange. On endoscopic retrograde cholangiopancreatography, the pancreatic stent was not visible at the papilla. The pancreatic duct was cannulated with a 0.025-inch guidewire (VisiGlide; Olympus America, Center Valley, Pennsylvania, USA). Fluoroscopy showed that the stent had migrated deeply into the pancreatic duct and that the guidewire had passed through the stent (●" Fig.1a,b). A novel method for stent retrieval was adopted. After ensuring that the tip of guidewire had passed through the migrated stent, we passed a 7-Fr, 7-cm stent over the guidewire and pushed it into the 10-Fr stent. After we confirmed under fluoroscopy that the 7-Fr stent had passed into the 10-Fr stent by monitoring the transmission of force through it, we removed the guidewire (●" Fig.1c). With the use of a foreign body forceps (Cook Medical, Bloomington, Indiana, USA) and a snare (Olympus, Tokyo, Japan), the 7-Fr/10-Fr stent “system” was withdrawn into the duodenum and finally removed (●" Fig.1d). Pancreatic stents can migrate distally in the pancreatic duct in up to 7.5% of patients and proximally in 5.2% of patients. These situations are clinically challenging, and surgical intervention may be required in 10% to 17% of cases [1–3]. Experienced endoscopists and dedicated devices are essential to increase the successful endoscopic retrieval of migrated stents. In practice, the availability of both is limited in many centers. Our novel technique requires only a guidewire and a pancreatic stent of smaller size, which are available in most centers. The chances of trauma to the pancreatic duct are less with this technique than with other techniques, in which an additional device must be accommodated within the pancreatic duct, increasing the likelihood of duct trauma.