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DOI: 10.1055/a-2418-0807
Successful removal of a migrated stent retriever tip using wire-guided forceps
Stent retriever dilation (Soehendra stent retriever, SSR-7; Cook, Tokyo, Japan) has demonstrated effectiveness in treating main pancreatic duct stenosis in chronic pancreatitis [1] [2]. However, there have been few reports on stent retriever tip breakage [3]. In this study, we describe a case of dislodgment of the stent retriever tip during main pancreatic duct stenosis owing to chronic pancreatitis, including the removal method.
A 56-year-old man was referred to our hospital for obstructive pancreatitis because of chronic pancreatitis-associated pancreatic stones. Initial endoscopic retrograde cholangiopancreatography (ERCP) demonstrated stenosis of the main pancreatic duct in the pancreatic body. A 5-Fr pancreatic stent was placed in the pancreatic head because it failed to pass through the body stenosis. Subsequently, contrast-enhanced abdominal computed tomography (CT) demonstrated persistent inflammation around the pancreatic body and tail ([Fig. 1]). Another ERCP was performed to place a pancreatic stent for body stenosis. Pancreatography demonstrated pancreatic body stenosis and extrapancreatic leakage of contrast agent at the stenosis site. Initially, the stenosis was partially dilated using a thin-tipped balloon catheter. Further caudal dilation was attempted; however, the catheter and another bougie dilator failed to pass through the stenosis. Subsequently, we dilated the stenosis using the SSR-7. When the SSR-7 was removed following dilatation, the tip was dislodged midway through the stenosis and remained in the pancreatic duct ([Video 1]). An attempt to remove the tip using biopsy forceps failed because it could not pass through the stenosis. Subsequently, a wire-guided single-opening biopsy forceps (E634044, 2.2-mm channel; Olympus, Tokyo, Japan) was used to successfully grasp and remove the dislodged tip through the stenosis ([Fig. 2]). The stenosis was dilated again using a thin-tipped balloon catheter, followed by the successful placement of a 5-Fr pancreatic stent at the stenosis site.
Quality:
Endoscopy_UCTN_Code_CPL_1AK_2AZ
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Publication History
Article published online:
08 October 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Brand B, Thonke F, Obytz S. et al. Stent retriever for dilation of pancreatic and bile duct strictures. Endoscopy 1999; 31: 142-145 DOI: 10.1055/s-1999-13662. (PMID: 10223363)
- 2 Kaul V, Geenen JE, Catalano MF. Soehendra stent retriever (SSR) for dilation of pancreatic and biliary strictures. Gastrointest Endosc 2007; 65: AB212 DOI: 10.1016/j.gie.2007.03.436.
- 3 Ogura T, Okuda A, Miyano A. et al. Successful digital cholangioscopy removal of a stent-retriever tip migrated into the periphery of the bile duct. Endoscopy 2018; 50: E113-E114 DOI: 10.1055/s-0044-101019.