Proximal Migration of Pancreatic Duct Stent in Pancreas Divisum: Challenges in Retrieval and Review of the Literature

Abstract

Pancreas divisum is the most common congenital malformation of the pancreas. Sometimes it is considered an etiology when patients present with recurrent episodes of pancreatitis. Endoscopic retrograde pancreatography (ERP) with selective cannulation of the minor papilla with sphincterotomy and stent placement are performed in these patients. Proximal migration of pancreatic stents in pancreas divisum is rare and challenging to manage. We describe a case of proximal migration of a pancreatic stent in a patient with pancreas divisum and perform a review of literature.

Successful removal of a proximally migrated pancreatic stent using a novel device delivery system

“…The removal of a proximally migrated pancreatic stent is technically challenging 1 2 3 . A novel device delivery system (EndoSheather; Piolax) was recently developed, which comprises a slim-tipped guide catheter and pusher tube that facilitate the insertion of devices up to 1.9 mm in diameter 4 5 .…”

Two‐devices‐in‐one‐channel method for fractured pancreatic duct stent retrieval in a case of severe chronic pancreatitis

“…Endoscopic pancreatic stenting is an effective management option for symptomatic chronic pancreatitis (CP) with pancreatic duct stenosis 1 . However, failure to retrieve plastic stents (PS) is associated with an increased risk of pancreatitis, duct injury, obstruction, and infection, which may require surgery 2–5 . PS, breaking during their removal, complicates their retrieval due to severe duct stenosis 4 .…”

“…This report describes PS fracture caused by an inappropriate extraction method. Various techniques for retrieving displaced pancreatic PS, such as using a basket, balloon catheter, stent retriever, and pancreatoscopy, have been reported 2–5 . The two‐devices‐in‐one‐channel method may be effective for difficult‐to‐retrieve PS.…”

“…1 However, failure to retrieve plastic stents (PS) is associated with an increased risk of pancreatitis, duct injury, obstruction, and infection, which may require surgery. [2][3][4][5] PS, breaking during their removal, complicates their retrieval due to severe duct stenosis. 4 We report the successful use of the two-devices-in-onechannel method to retrieve a fragmented, displaced pancreatic PS.…”