An Wei, Wang Dan, Cai Yi-Li, Wang Teng, Qi Ke, Yang Ting, Li Zhao-Shen, Hu Liang-Hao
Department of Gastroenterology, ChangHai Hospital, Naval Medical University, Shanghai, China.
Digestive Endoscopy Center, ChangHai Hospital, Naval Medical University, Shanghai, China.
Heliyon. 2022 Sep 29;8(10):e10800. doi: 10.1016/j.heliyon.2022.e10800. eCollection 2022 Oct.
Endoscopic pancreatic stenting is an effective way to relieve the stricture of the pancreatic duct. However, proximal stent migration presents a threat to the patient and a challenge to the doctor. The limited space in the pancreatic duct often prevents the operation of suitable devices for stent removal.
A 34-year-old man with painful chronic pancreatitis received endoscopic retrograde cholangiopancreatography (ERCP) and insertion of a pancreatic plastic stent, with 8.5 Fr in diameter and 12 cm in length. A year later, radiography revealed that the proximal end of the stent rested in the pancreatic tail while the distal end rested in the branch duct. Both balloon and rat-tooth forceps were used but failed to retrieve the stent. A week later, a second ERCP was performed. After dilation with a 10-mm balloon, a small amount of bleeding was noticed and a crack appeared in the wall of the branch duct. Consequently, the distal end of the stent was released. Then, rat-tooth forceps was used to grasp the distal end, and the stent was pulled out successfully.
For a proximally migrated pancreatic stent stuck at both ends, a strategy of maximum dilation can be used cautiously to retrieve the stent.
内镜下胰管支架置入术是缓解胰管狭窄的有效方法。然而，支架近端移位对患者构成威胁，也给医生带来挑战。胰管内空间有限，常常妨碍使用合适的器械取出支架。
一名34岁慢性胰腺炎伴疼痛的男性患者接受了内镜逆行胰胆管造影术（ERCP）并置入了一枚直径8.5 Fr、长度12 cm的胰管塑料支架。一年后，影像学检查显示支架近端位于胰尾，远端位于分支胰管。使用球囊和鼠齿钳均未能取出支架。一周后，进行了第二次ERCP。用10 mm球囊扩张后，发现有少量出血，分支胰管壁出现一道裂缝。结果，支架远端松开。然后，用鼠齿钳抓住远端，成功将支架取出。
对于两端卡住的近端移位胰管支架，可谨慎采用最大扩张策略取出支架。
