Endoscopic pancreatic stenting for symptomatic strictures is beneficial to patients
with chronic pancreatitis [1]. However, stent-related problems occur, including migration and immobility, which
are more serious for pancreatic stents than for biliary stents because the pancreatic
duct bends and is narrow [2]. We encountered a rare case with a pancreatic stent that could not be removed using
forceps and was successfully retrieved using a novel thin-tipped balloon catheter.
A 77-year-old man with chronic pancreatitis was admitted for abdominal pain caused
by a severe main pancreatic duct stricture. A 7-Fr plastic stent (Boston Scientific
Corporation, Marlborough, Massachusetts, USA) was placed and his symptoms improved
([Fig. 1]). Endoscopic retrograde cholangiopancreatography (ERCP) was performed 3 months later
to retrieve or exchange the stent. However, when we attempted to remove the stent
with forceps, resistance was encountered, the stent did not move and part of it tore
off ([Fig. 2]). This was probably associated with the severity and length of the stricture, and
stent degradation. After the lumen of the stent had been cannulated with a 0.025-inch
guidewire, a novel balloon catheter with a thinner tip (REN Biliary Balloon Dilation
Catheter; 4-mm wide, 30-mm long; Kaneka Corporation, Osaka, Japan) was inserted, inflated
inside the stent, and we attempted to pull the stent down ([Fig. 3]). The stent was successfully retrieved without any adverse events ([Video 1]).
Fig. 1 The main pancreatic duct stricture in the pancreatic body was 35-mm long and very
severe. The procedure involved: a dilation using a Soehendra stent retriever (Cook Medical Inc., Bloomington, Indiana,
USA); b placement of a 7-Fr plastic stent across the stricture.
Fig. 2 Images from an attempt to remove the pancreatic stent 3 months after its placement
showing: a failure to remove the stent with forceps; b the remnant of the stent after part of it had torn off; c the torn-off section of stent present in the duodenal bulb.
Fig. 3 Images of the successful balloon-catheter removal of the stent showing: a a guidewire inserted into the stent’s lumen; b, c a balloon dilation catheter with a thinner tip inserted and inflated inside the stent,
which allowed the stent to be pulled down.
Video 1: The pancreatic stent could not be removed using forceps and part of it tore off.
After a guidewire had been inserted, a balloon dilation catheter with a thinner tip
was inserted and inflated inside the stent. The catheter was then pulled down, and
the stent was successfully removed through the scope.
Although rare, an immovable pancreatic stent can be a major complication. Removal
using forceps can tear off a plastic stent that is immobile and perishing. The novel
balloon catheter used to retrieve the stent from this patient has a tapered and thinner
3-Fr tip that is of adequate rigidity ([Fig. 4]) [3]. Hence, when forceps cannot remove a pancreatic stent, balloon retrieval should
be attempted, and the aforementioned thin-tipped balloon catheter may be more suitable
for this procedure than other conventional balloon catheters.
Fig. 4 The novel balloon catheter has a tapered and thinner 3-Fr tip that has adequate rigidity
and good pushability.
Endoscopy_UCTN_Code_CPL_1AK_2AD
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