Fracture of a pancreatic stent during endoscopic retrieval is a recognized and technically challenging complication. The fractured proximal stent fragment is often anchored by its flaps within a pancreatic duct branch or a ductal stricture, making retrieval by simple traction difficult. When a guidewire can be advanced through the fractured distal end into the stent lumen, several endoscopic salvage techniques are available. 1 2 3 However, rescue options are limited when the stent lumen cannot be accessed with a guidewire. 4 5 Here, we describe a simple forceps elevator-assisted technique for retrieval of a fractured, proximally migrated, and firmly anchored pancreatic stent.
A 68-year-old man with chronic pancreatitis underwent endoscopic retrieval of a 7-Fr pancreatic duct stent ( Fig. 1 ). The initial retrieval attempt using a snare catheter failed because the proximal flaps were impacted within a pancreatic duct branch. During the attempt, the stent fractured, and the remaining proximal stent dislodged completely into the main pancreatic duct. Subsequent retrieval attempts using a retrieval basket and an extraction balloon were unsuccessful. Biopsy forceps (Radial Jaw 4; Boston Scientific, Marlborough, MA, USA) were advanced under fluoroscopic guidance to grasp the retained stent. Although the distal end of the stent was successfully pulled through the major papilla, complete extraction was prevented because the proximal flaps remained firmly anchored within the pancreatic duct branch. The previously reported “retracting flaps technique” 4 was not applicable because the retained stent was 7 Fr in diameter. We therefore used a forceps elevator-assisted retrieval technique. The distal end of the fractured stent was grasped with the biopsy forceps, retracted into the tip of the duodenoscope, and then secured by raising the forceps elevator ( Figs. 2 and 3 ). Finally, the duodenoscope and forceps were withdrawn as a single unit, enabling the successful retrieval of the stent ( Video 1 ).
Fig. 1.
A fluoroscopic image showing the pancreatic stent before fracture during retrieval with a snare catheter.
Fig. 2.
A fluoroscopic image showing the fractured stent fragment after complete migration into the main pancreatic duct, being grasped with biopsy forceps.
Fig. 3.
Endoscopic images showing ( a ) the distal end of the fractured stent being grasped with biopsy forceps and ( b ) the stent secured within the duodenoscope tip by raising the forceps elevator.
Video 1 Endoscopic retrieval of a fractured and migrated pancreatic stent using a forceps elevator-assisted technique. Video URI: .
Endoscopy_UCTN_Code_TTT_1AR_2AZ
Footnotes
Conflict of Interest The authors declare that they have no conflict of interest.
Contributorsʼ Statement Sho Kitagawa: data curation, investigation, visualization, and writing – original draft. Narito Murakoshi: investigation and writing – review and editing. Naoki Shiga: writing – review and editing.
References
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