Endoscopy 2007; 39: E42
DOI: 10.1055/s-2006-945064
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic removal of proximally migrated pancreatic stent by a grasping tripod

R. Rerknimitr1 , W. Phuangsombat1 , P. Naprasert1
  • 1Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Thailand
Further Information

R. Rerknimitr, MD

Gastroenterology Unit

Department of Internal Medicine
Faculty of Medicine
Chulalongkorn University
Bangkok 10330
Thailand

Fax: +66-2-252-7839

Email: rungsun@pol.net

Publication History

Publication Date:
07 February 2007 (online)

Table of Contents

A 30-year-old man was referred for an endoscopic removal of proximally migrated pancreatic stent. At our institution, the initial attempt by endoscopic removal using a snare, basket and balloon extraction failed. The distal tip of the stent was impacted at the side wall of the pancreatic duct. A rat-tooth forceps was also tried and was able to access the tip of the stent. Unfortunately, it could not be opened fully due to the small size of the pancreatic duct. During subsequent endoscopic retrograde cholangiopancreatography, a Caesar grasping tripod (Wilson-Cook, Winston-Salem, North Carolina) was used. Within the first attempt, the tripod was able to grasp the tip of the stent firmly enough to allow stent removal (Figure [1] and [2]).

Zoom Image

Figure 1 Endoscopic removal of pancreatic stent by a grasping tripod.

Zoom Image

Figure 2 A firm grip of the pancreatic stent by a grasping tripod outside the patient.

Removal of proximally migrated stent is technically challenging. Basket or snare removal is a standard technique [1]. However, with the tip of the stent impacting the duct this technique may not be successful. An inflating balloon catheter for counter traction and removal of the stent has been reported to be helpful [2]. A rat-tooth forceps is also used but a small pancreatic duct can preclude full opening of the forceps. A grasping tripod, which requires a smaller space in order to open, is our recommended device for proximally migrated pancreatic stent that is impacting a small duct.

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References

R. Rerknimitr, MD

Gastroenterology Unit

Department of Internal Medicine
Faculty of Medicine
Chulalongkorn University
Bangkok 10330
Thailand

Fax: +66-2-252-7839

Email: rungsun@pol.net

#

References

R. Rerknimitr, MD

Gastroenterology Unit

Department of Internal Medicine
Faculty of Medicine
Chulalongkorn University
Bangkok 10330
Thailand

Fax: +66-2-252-7839

Email: rungsun@pol.net

Zoom Image

Figure 1 Endoscopic removal of pancreatic stent by a grasping tripod.

Zoom Image

Figure 2 A firm grip of the pancreatic stent by a grasping tripod outside the patient.