Clinic Usefulness of an Algorithm for Endoscopic Retrieval of Proximally Migrated Pancreatic Stents

Background: Proximal migration of pancreatic stents (PMPS) is an infrequent event but its management can be technically challenging and there are no standard retrieval methods. The objective of this study was to determine the results of an endoscopic stent retrieval algorithm in terms of feasibility and efficacy of the endoscopic procedure. Methods: During the period from Jan 2008 to Dec 2009, 15 patients (8 women and 7 men with a mean age of 51.9 years) with PMPS were included in this study. Stent retrieval was approached initially with balloon extraction followed by rat-tooth forceps and basket. A rescue approach such as using a stent retriever was attempted when other approaches failed. Results: All the PMPS were retrieved successfully within one ERCP session. Balloon extraction was successful in 9 (60%) patients. In the 6 failed cases of balloon extraction, wire-guided rat-tooth forceps grasp was successful in 4 patients, stone extraction basket grasp was successful in 1 patient who failed forceps grasp. One stent was finally rescued with a stent retriever when balloon extraction, forceps and basket grasp all failed. In patients with successful balloon extraction, 44.4% of the patients (4/9) developed post-ERCP hyperamylasemia but none of them developed post-procedure pancreatitis. Conclusion: With this algorithm; PMPS was successfully retrieved in all of the cases. Most PMPS retrieval can be safely achieved with commonly used approaches. Those less used approaches can be used as a rescue method.