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Successful removal of deeply migrated pancreatic stent using biliary dilation balloon and the new single-operator digital cholangioscope

      A 73-year-old woman who had previously undergone unsuccessful ERCP for choledocholithiasis underwent successful ERCP with extraction of a large stone and subsequent pancreatic duct (PD) stent placement for post-ERCP pancreatitis prophylaxis. The stent migrated spontaneously deep into the PD and could not be retrieved with standard ERCP tools, including grasping forceps, snares, and extraction balloon. An innovative technique was then devised whereby a 4 cm × 4 mm biliary dilation balloon was carefully placed alongside the stent, and the stent was dragged down from the deeper portions of the PD. Subsequently, a digital cholangioscope was used to visualize the stent, and retrieval with through-the-cholangioscope forceps was successful (Fig. 1; Video 1, available online at www.giejournal.org). Removal of proximally migrated PD stents can be extremely challenging because of the small diameter of the PD, its bent course, the presence of strictures, and a lack of suitable devices for stent removal. For these reasons, the endoscopist’s experience and ability to innovate is of critical importance for successful retrieval. This is a novel case of removal of a deeply migrated PD stent by use of a biliary dilation balloon and the new digital cholangioscope. This technique was conceived when all standard measures for removing a deeply migrated stent had failed.
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      Figure 1A, Dragging stent down from deep PD using 4 mm × 4 cm balloon under fluoroscopy. B, Retrieval of stent using direct cholangioscopy forceps.
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