P2907 - Endoscopic Retrieval of Fractured Pancreatic Plastic Stent Fragments: One Approach May Not Fit All!

Naman Suroya, MBBS¹, Anfal Atif, MBBS², Asad Jehangir, MD¹, Nitin N. Rao, MBBS¹, Haoran Peng, MD, PhD¹, Donna Edwards, RN¹, Robert Jones, RN¹, Subbaramia Sridhar, MBBS, MPH^3
1Medical College of Georgia at Augusta University, Augusta, GA; ²Dow University of Health Sciences, Karachi, Sindh, Pakistan; ³Augusta University Medical Center, Augusta, GA

Introduction: Plastic stents are often used in patients with pancreatic duct (PD) strictures from chronic pancreatitis (CP). However, sometimes these stents can fragment during retrieval. The fragmented stents are challenging to remove as they often migrate deep in to the PD. Stent retention can cause complications e.g. bleeding, infection and perforation. The endoscopists need to be have alternative options in their armamentarium to successfully retrieve these fragmented stents.

Case Description/Methods: First patient: A 59- year old female with CP had an ERCP for PD stent removal. Using a rat tooth forceps, the indwelling 10 Fr, 12 cm long PD stent was removed. The inner flange of the stent was fractured and retained in the main PD near the tail of pancreas. Pancreatogram showed tortuous PD, long stricture of the PD involving the head and the genu, dilated PD segment to 1 cm, and filling defects near the genu (Image 1A). An extraction balloon catheter could not be passed beyond the genu. Using a dilatation balloon, the entire PD was dilated to 6 mm. Then, using the inject-below extraction balloon 2 large PD stones were removed. Finally, the stent fragment was also removed. At the end a 10 Fr, 12 cm single pig-tail plastic stent with internal flange was inserted in the PD.



Second patient: A 34-year-old female with CP and stricture in the genu/proximal pancreas body underwent ERCP removal of a 10 Fr, 12 cm PD plastic stent. With the help of a snare, the stent was pulled out but no internal flange was seen. Then the impacted stent flange was identified near the tail of the pancreas. Attempts to remove this via a 6 mm dilatation balloon displaced the fragmented stent further. Attempts to retrieve the fragmented stent using stone extraction balloon and mini basket also failed. Finally, a mini biopsy forceps with no internal nail was advanced in to the PD alongside the guidewire also failed. The guidewire was removed and after multiple attempts, the fractured flange was grasped firmly and removed out of the ampulla (Images 1B and C). Finally, a 10 Fr, 12 cm long Johlin plastic stent, without internal flange, was placed in the main PD.

Discussion: Plastic stents are useful in management of patients with PD strictures. However, these stents may occasionally fragment during their removal. When balloon dilatation, extraction balloons and retrieval baskets fail, use of mini forceps, sometimes may aid in successful retrieval of fragmented stents.



Disclosures:


Naman Suroya, MBBS¹, Anfal Atif, MBBS², Asad Jehangir, MD¹, Nitin N. Rao, MBBS¹, Haoran Peng, MD, PhD¹, Donna Edwards, RN¹, Robert Jones, RN¹, Subbaramia Sridhar, MBBS, MPH³. P2907 - Endoscopic Retrieval of Fractured Pancreatic Plastic Stent Fragments: One Approach May Not Fit All!, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.