Endoscopy 2010; 42: E5-E6
DOI: 10.1055/s-0029-1215418
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic retrieval of a proximally migrated pancreatic stent: variation of the lasso technique

J.  J.  Vila1 , D.  Ruiz-Clavijo2 , I.  Fernández-Urién1 , A.  Martínez2 , M.  Kutz2 , I.  Elizalde2 , J.  M.  Zozaya2
  • 1Endoscopy Unit, Department of Gastroenterology, Hospital de Navarra, Pamplona, Spain
  • 2Department of Gastroenterology, Hospital de Navarra, Pamplona, Spain
Further Information

Dr. J. J. Vila

Gastroenterology Department
Hospital de Navarra

c/Irunlarrea 3
31008 Pamplona
Spain

Fax: 0034-848422303

Email: juanjvila@gmail.com

Publication History

Publication Date:
11 January 2010 (online)

Table of Contents

Many devices have proved to be useful to retrieve proximally migrated pancreatic stents [1] [2]. The lasso technique involves inserting a guide wire through the lumen of the migrated stent followed by insertion of a partially opened polypectomy snare over the wire to grasp the stent [3].

We present the case of a 72-year-old woman with recurrent acute biliary pancreatitis, who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary sphincterotomy due to high surgical risk. During the ERCP procedure, a flared pancreatic stent (diameter 5 Fr; length 5 cm) was placed. However, in spite of the stent, the patient developed pancreatitis. A computed tomography (CT) scan showed proximal migration of the pancreatic stent ([Fig. 1]), and another ERCP procedure was carried out to retrieve it.

Zoom Image

Fig. 1 CT scan showing the migrated pancreatic stent in the pancreatic duct (arrow). There are signs of acute postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.

The pancreatic duct was deeply cannulated with a guide wire introduced alongside the stent. We then threaded the external end of the wire through a partially opened polypectomy snare ([Fig. 2]) and gently closed the snare and introduced it over the wire in the pancreatic duct until it reached the distal end of the stent ([Fig. 3]).

Zoom Image

Fig. 2 The polypectomy snare threaded over the wire for insertion into the pancreatic duct.

Zoom Image

Fig. 3 Fluoroscopic image of the migrated stent (both ends marked with white arrows), the guide wire alongside it, and the polypectomy snare inserted over the wire at the level of the genu (arrowhead).

At this point, we gently opened the snare ([Fig. 4]) and manipulated it until we had lassoed the stent.

Zoom Image

Fig. 4 The opened snare inside the pancreatic duct (arrowhead) being manipulated to grasp the stent (white arrow) and the wire simultaneously.

We then extracted the entire stent pulling the snare and the wire simultaneously ([Fig. 5]).

Zoom Image

Fig. 5 Simultaneous extraction of the stent and the wire from the pancreatic duct. Once the stent had been fully retrieved, the guide wire, whose proximal end was still in the pancreatic duct, was inserted again without the need to recannulate.

The patient had an uneventful recovery following the procedure.

The present variation of the previously described lasso technique [3] consists of inserting the guide wire alongside the stent rather than through the stent lumen. Like the original technique, this maneuver allowed us to gently insert a polypectomy snare into the pancreatic duct up to the level of the genu, and then open it within the pancreatic duct to lasso the stent and wire and extract them simultaneously. Since the guide wire was deeply placed in the pancreatic duct, further access to the pancreatic duct was maintained without the need for recannulation.

Endoscopy_UCTN_Code_TTT_1AR_2AZ

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References

Dr. J. J. Vila

Gastroenterology Department
Hospital de Navarra

c/Irunlarrea 3
31008 Pamplona
Spain

Fax: 0034-848422303

Email: juanjvila@gmail.com

#

References

Dr. J. J. Vila

Gastroenterology Department
Hospital de Navarra

c/Irunlarrea 3
31008 Pamplona
Spain

Fax: 0034-848422303

Email: juanjvila@gmail.com

Zoom Image

Fig. 1 CT scan showing the migrated pancreatic stent in the pancreatic duct (arrow). There are signs of acute postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.

Zoom Image

Fig. 2 The polypectomy snare threaded over the wire for insertion into the pancreatic duct.

Zoom Image

Fig. 3 Fluoroscopic image of the migrated stent (both ends marked with white arrows), the guide wire alongside it, and the polypectomy snare inserted over the wire at the level of the genu (arrowhead).

Zoom Image

Fig. 4 The opened snare inside the pancreatic duct (arrowhead) being manipulated to grasp the stent (white arrow) and the wire simultaneously.

Zoom Image

Fig. 5 Simultaneous extraction of the stent and the wire from the pancreatic duct. Once the stent had been fully retrieved, the guide wire, whose proximal end was still in the pancreatic duct, was inserted again without the need to recannulate.