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

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.