Endoscopic removal of proximally migrated pancreatic duct stents: a case series and literature review

Abstract

Background Proximal migration of pancreatic stents is an uncommon but significant problem that poses risks of pain and pancreatitis. It is often a challenging situation for endoscopists, necessitating surgical retrieval in 10% of cases.

Method A 10-year retrospective review was performed of stent removal procedures performed at a tertiary care center in northern India between January 2010 and December 2019.

Results Sixteen patients (mean age 39.52 years, 13 [81.25%] males) with proximally migrated pancreatic stents (PMPSs) were studied. Thirteen (81.25%) patients had a dilated pancreatic duct (PD) and 3 (18.75%) had a non-dilated PD. In the majority of patients, the PMPSs were located at the genu (50%), while 62% were 10 cm in length. Three (18.75%) patients had fragmented stents, whereas the remaining 13 (81.25%) had intact stents in situ. Complete retrieval of the PPMS and stent fragments was possible in 12 (75%) patients, with grasping forceps being used in the majority (50%). In patients with fragmented stents and difficult locations (n=3), pancreatoscopy-assisted techniques resulted in the retrieval of the stent or fragments. PMPSs could not be retrieved in 3 patients: all these failures were during the study period when a SpyGlass pancreatoscope was not available in our unit. Two patients (12.5%) reported post-procedural pain that responded to intravenous analgesics.

Conclusions Endoscopic retrieval of proximally migrated stents, using a combination of techniques and accessories, is safe and effective. Pancreatoscopy increases the success rates. Surgery is rarely required for stent removal.

Keywords Endoscopy, pancreas, stents, endoscopic retrograde cholangiopancreatography, pancreatitis

Ann Gastroenterol 2025; 38 (2): 230-236