Good stents gone bad: endoscopic treatment of proximally migrated pancreatic duct stents.
BACKGROUND
Pancreatic duct stents are used for a variety of endoscopic pancreatic manipulations, and small surgical stents are used prophylactically to bridge pancreatic-enteric anastomoses. With increasing use of pancreatic stents, many complications have been recognized.


OBJECTIVE
To determine the complications and outcomes of pancreatic stent migration.


METHODS
Case series from a retrospective review of all cases of upstream or proximally migrated pancreatic duct stents, placed either endoscopically or surgically, identified between 2000 and 2007.


METHODS
Tertiary referral center.


METHODS
This study involved 33 patients; 23 postendoscopic and 10 postsurgical stents.


METHODS
Retrieval rates, minor/major complications.


RESULTS
Endoscopic stents had a successful retrieval rate of 78%. Most patients were asymptomatic. The most common procedure was balloon extraction (8 of 18; 44%). Nine patients required multiple procedures (3 patients, 2 attempts; 5 patients, 3 attempts; 1 patient, 4 attempts). Five stents could not be retrieved. Of these, 4 were associated with downstream stenosis. Four patients underwent surgery, and 1 patient was treated with observation. Complications included pancreatic duct disruption (1 of 23), stent fragmentation (1 of 23), and postprocedure pancreatitis (1 of 23). Surgically placed stents had a successful retrieval rate of 80%. Most surgical stents had migrated into the biliary tree (8 of 10). All of these patients were symptomatic with pain or fever. Two stents could not be retrieved; 1 of those patients underwent surgery.


CONCLUSIONS
Retrospective study.


CONCLUSIONS
The majority of upstream-migrated stents can be endoscopically removed. Despite manipulation of the pancreatic duct, pancreatitis was infrequent. Surgically placed pancreatic stents migrate downstream and into the open biliary anastomosis and are associated with pain, cholangitis, or liver abscesses.
Price
Leslie H
LH
Virginia Mason Medical Center, Seattle, Washington 98101, USA.
Brandabur
John J
JJ
Kozarek
Richard A
RA
Gluck
Michael
M
Traverso
William L
WL
Irani
Shayan
S
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery*; D010183:Pancreatic Ducts / Q000601:surgery*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome