Matsumoto Kazuyuki, Katanuma Akio, Maguchi Hiroyuki
Center for Gastroenterology, Teine-Keijinkai Hospital, 1-jo 12-chome, Maeda, Teine-ku, Sapporo, 006-8555, Japan.
J Hepatobiliary Pancreat Sci. 2014 Jun;21(6):E34-40. doi: 10.1002/jhbp.94. Epub 2014 Feb 17.
Endoscopic pancreatic stenting (EPS) is used for various pancreatic conditions. With the increasing use of pancreatic stents, many complications have been observed. Especially, proximal stent migration presents a more serious condition because of the possibility of pancreatic duct (PD) damage. However, the removal of proximally migrated stents is technically challenging because of the small PD diameter, the bended PD course, the presence of PD strictures, and the lack of suitable devices for stent removal. Thus, few cases of surgical intervention have been encountered. In this study, we review the endoscopic treatment of proximally migrated pancreatic plastic stents. We classify migrated stent conditions into four types according to stent and PD conditions. In Type A, the main pancreatic duct (MPD) has no stricture. In Type B, the stent is positioned across the stricture on the MPD. In Type C, the stent is positioned further away from the stricture on the MPD. The tip of the proximal stent is located in the MPD in types A thru C. In Type D, the tip of the proximal stent is located in a branch duct. We introduced the strategy of endoscopic removal technique of each type of migrated plastic stents.
内镜下胰腺支架置入术（EPS）用于治疗各种胰腺疾病。随着胰腺支架使用的增加，已观察到许多并发症。特别是，近端支架移位由于可能损伤胰管（PD）而呈现出更严重的情况。然而，由于胰管直径小、胰管走行弯曲、存在胰管狭窄以及缺乏合适的支架取出装置，取出近端移位的支架在技术上具有挑战性。因此，很少遇到手术干预的病例。在本研究中，我们回顾了近端移位的胰腺塑料支架的内镜治疗。我们根据支架和胰管情况将移位支架的情况分为四种类型。在A型中，主胰管（MPD）无狭窄。在B型中，支架横跨MPD上的狭窄部位定位。在C型中，支架位于离MPD上的狭窄部位更远的位置。在A至C型中，近端支架的尖端位于MPD内。在D型中，近端支架的尖端位于分支导管内。我们介绍了每种类型移位塑料支架的内镜取出技术策略。
