Very rare case of pancreatic stent migration into the biliary stent

Abstract

Pancreatic duct stenting is often performed to prevent postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis,^{1, 2} but adverse events (AEs), including stent migration, can occur. Although endoscopic pancreatic stent (EPS) sometimes migrates into the pancreatic duct,^3-5 there is no report about the migration of EPS into the endoscopic biliary stent (EBS). Herein, this is a first case in which EPS had migrated into the EBS.

A 76-year-old woman with obstructive jaundice due to a pancreatic head mass was referred to our hospital. An EBS (7F 7 cm, Flexima; Boston Scientific Japan, Tokyo, Japan) was placed to treat the obstructive jaundice, while an EPS (5F 3 cm, Geenen; Cook Medical, Bloomington, IN, USA) was placed to prevent post-ERCP pancreatitis (Fig. 1). Seven days later, an endoscopic ultrasound to exam the pancreatic head mass indicated that the EPS had migrated into the EBS. ERCP was immediately performed, confirming the EPS migration (Fig. 2a,b). We grabbed the EPS and EBS tips with a snare and removed them in one batch. No AEs occurred when we removed the EPS and EBS. After snare removal of both the EPS and EBS (Fig. 2c), a covered biliary metal stent (10 mm × 7 cm, BONASTENT Biliary; Medico's Hirata Inc., Osaka, Japan) was placed, and the obstructive jaundice subsequently improved (Video S1). In this case, the EPS had migrated through a side hole of the EBS and was emerging from the tip of the EBS. Fortunately, even with the EPS migrating into the EBS, improvement of obstructive jaundice was not delayed. And obstructive pancreatitis did not occur. Probably, bile and pancreatic juice were draining through the common ducts of the EBS and EPS. Although a pigtail stent can prevent the stent migration, it is difficult to predict this AE when using a straight-type stent. Endoscopists should be aware of this rare AE of EPS.

Authors declare no conflict of interest for this article.