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Abstract
Background Proximal migration is one of the complications after pancreatic stenting. This study aims to determine the incidence, risk factors, and endoscopic treatment of proximally migrated pancreatic stents.
Methods A retrospective search of all the endoscopic retrograde cholangiopancreatography (ERCP) records was conducted from 1997 to 2022 in Changhai Hospital. Proximal migration of the pancreatic stent was defined as when the stent shifted completely into the pancreatic duct and the distal end of the stent was no longer visible at the duodenal papilla. Balloon, forceps, basket (4 wires or 8 wires), snare, and Soehendra stent retriever (SSR) were used to extract proximally migrated pancreatic stents under ERCP. Some migrated stents necessitated multiple ERCP removal attempts. Whether or not the migrated stent was successfully removed, a new pancreatic stent was typically placed for drainage. The study was approved by the Ethics Committee of Changhai Hospital, Naval Medical University, Shanghai, China. This research was registered at ClinicalTrials.gov as NCT05431517.
Results A total of 9017 pancreatic duct stentings of 6083 patients were performed (IDDF2024-ABS-0399 Figure 1. Flow diagram of this study design). The proximal migration rate was 0.2% (17/9017). Three predictive factors for proximal migration were identified: pancreatic duct stones (odds ratio [OR], 0.107), residual pancreatic duct stones (OR, 8.290) and stent shape (straight type) (OR, 4.725). After including 19 patients transferred from other hospitals, 46 ERCPs were performed to retrieve the proximally migrated stents in 36 patients. The success rate of endoscopic removal was 80.6% (29/36). 1 (2.8%) patient was referred to surgery, and 6 patients had new pancreatic stents placed for conservative treatment. 21.7% (10/46) cases developed post-ERCP pancreatitis and 2.2% (1/46) developed infection. IDDF2024-ABS-0399 Figure 2 shows the X-ray images of different accessories when removing the migrated pancreatic stent.
Flow diagram of this study design.
X-ray images of migrated pancreatic stent removal using different accessories. a: Balloon, b: Forceps, c: Basket, d: Snare, e: In vitro simulation of removing the migrated stent using a snare, f: Soehendra stent retriever.
Conclusions Proximal migration of pancreatic stents is less common but deserves more attention. Endoscopy is efficient in retrieving proximally migrated stents. In patients with residual pancreatic duct stones and straight stents, the risk of proximal migration is markedly increased.