Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center.
BACKGROUND
Proximal migration of a biliary or pancreatic stent is an infrequent event but its management can be technically challenging.


METHODS
Review of all cases of proximally migrated biliary and pancreatic stents over a 10-year period at a referral pancreatic-biliary center. Data abstracted from patient records included indication for stenting, method of presentation, success of attempt, and method used. Successful methods were determined by reviewing procedure reports. Follow-up was attempted in all patients in whom stent retrieval had failed.


RESULTS
Thirty-three proximally migrated bile duct stents, and 26 proximally migrated pancreatic duct stents were identified. Most of the patients were without symptoms. Eighty-five percent of common bile duct stents and 80% of pancreatic duct stents were successfully extracted endoscopically. Seventy-one percent (34 of 48) were retrieved with a basket or balloon. Of the stents not retrieved, two patients did not return for repeat ERCP, three patients with malignant common bile duct strictures were managed with placement of a second stent, three patients with pancreatic duct stents have remained without symptoms with no further retrieval attempts, and three patients with proximally migrated pancreatic duct stents required surgery because of pain and failure of multiple endoscopic retrieval attempts.


CONCLUSIONS
Over 80% of proximally migrated bile duct and pancreatic duct stents may be extracted endoscopically. Few patients will require surgery.
Lahoti
S
S
The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Catalano
M F
MF
Geenen
J E
JE
Schmalz
M J
MJ
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D004724:Endoscopy / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D012017:Referral and Consultation; D012086:Reoperation; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome