Endoscopic Retrieval of a Proximally Migrated, Deeply Embedded Pancreatic Duct Stent Using a Rat Tooth Forceps

Abstract

Case Report: A 33-year-old female who had undergone multiple ERCPs for recurrent abdominal pain was admitted to our hospital with persistent pain and pancreatitis 9 days post-ERCP. Prior pancreatic duct (PD) stent placement was complicated by proximal migration into the PD. Multiple failed attempts at stent retrieval with a basket, stent retriever, balloon, and autotome all failed to successfully engage the stent, and only pushed the stent more proximally. Endoscopic retrieval of the migrated stent was then attempted at our institution. The PD was cannulated with a 3.9F sphincterotome (Boston Scientific) preloaded with a.021 inch diameter guidewire (Wilson-Cook). Pancreatogram showed the stent deeply embedded in the tail. An initial retrieval attempt using a 4 mm x 2 cm Hurricane Rx Dilation Balloon (Boston Scientific) partially inflated alongside the stent to facilitate traction removal was unsuccessful. We then advanced a rat tooth alligator jaw grasping forceps (Olympus) to the tail, successfully grabbed the stent, and removed the stent by carefully withdrawing the forceps (Figure 1). Repeat pancreatogram revealed no evidence of contrast extravasation from the PD. A 5F 10 cm Zimmon pancreatic stent (Wilson-Cook) was placed. The patient's pancreatitis improved over the next several days.Figure 1Discussion: The majority of proximally migrated PD stents can be retrieved using the same techniques and devices that are utilized for the retrieval of migrated biliary endoprostheses. In difficult cases, surgical intervention or the use of novel techniques utilizing interventional radiologic accessories have been reported. In the present case, we demonstrated the removal of a deeply embedded, proximally migrated PD stent with the use of standard grasping forceps. We report the novel technique of using a rat tooth forceps for the retrieval of a deeply embedded PD stent. This modality is safe and demonstrates that standard endoscopic accessories can be utilized in favor of less readily available interventional equipment from fields outside of gastroenterology. [figure 1]