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Stent removal using novel balloon catheter after rupture of stent for EUS-guided pancreatic duct drainage


 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan

Date of Submission11-Jul-2017
Date of Acceptance08-Jan-2018
Date of Web Publication25-May-2018

Correspondence Address:
Takeshi Ogura,
2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686
Japan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_10_18

PMID: 29798940



How to cite this URL:
Ogura T, Okuda A, Nishioka N, Kamiyama R, Higuchi K. Stent removal using novel balloon catheter after rupture of stent for EUS-guided pancreatic duct drainage. Endosc Ultrasound [Epub ahead of print] [cited 2018 Dec 17]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=233176



EUS-guided pancreatic duct drainage (EUS-PD) for pancreatic duct obstruction has been reported as a rescue procedure after failed ERCP.[1],[2],[3],[4] After this procedure, continuous stent exchange may be needed to keep the fistula and preventing stent obstruction. Usually, because main pancreatic duct is relatively narrow compared with bile duct, straight plastic stent may be used. Recently, to prevent stent migration, novel plastic stent(TypeIT, Gadelius Medical Co., Ltd., Tokyo, Japan) has been reported.[5] Herein, we report a case of stent rupture during exchanging the stent of EUS-PD and describe technical tips for re-intervention.

A 52-year-old womanwas admitted to our hospital due to abdominal pain and elevation of pancreatic enzyme. On computed tomography, large pancreatic pseudocyst and pancreatic duct stones were seen. To perform decompression of the pancreatic duct, ERCP was attempted. However, ERCP catheter could not be advanced beyond the stones. Therefore, we selected EUS-PD as rescue procedure. First, the dilated pancreatic duct was punctured, and the contrast medium was injected. After fistula dilation, stent deployment from the pancreatic duct to the stomach was performed using TypeIT(7 Fr, 12cm, Gadelius Medical Co. Ltd., Tokyo, Japan). This stent has four flanges; two in the distal end and two at the proximal end. Apigtail is present at the proximal end, and the distal end is tapered.[5] After this procedure, pancreatic pseudocyst was completely resolved. After 1month, ERCP was attempted because of stent occlusion. First, the guidewire was inserted into the fistula [Figure 1], and the stent removal was attempted using grasping forceps. However, stent rupture occurred [Figure 2] and [Figure 3].
Figure 1: The guidewire is inserted into the pancreatic duct through the fistula

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Figure 2: Stent rupture is occurred

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Figure 3: Complete rupture is seen in endoscopic view

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Because any devices such as the guidewire or balloon catheter could not be inserted into the fistula, the guidewire was inserted into the ruptured stent [Figure 4] and [Figure 5]. Next, fine gauge balloon catheter(4mm, REN biliary dilation catheter; KANEKA, Osaka, Japan,) was inserted into the ruptured stent [Figure 6]. The tip of this balloon catheter is only 3 Fr and tapered. In addition, this balloon catheter is coaxial with the guidewire, therefore, can be easily inserted within the plastic stent. Finally, we successfully removed the ruptured stent, and new plastic stent could be placed. The stent, which was used in this case, has double side hole in the proximal end, therefore, this site may be easily ruptured compared with conventional stent. It may be important to grasp the more distal end from this site.
Figure 4: Endoscopic retrograde cholangiopancreatography catheter is inserted into the ruptured stent

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Figure 5: The guidewire is inserted into the ruptured stent, and balloon catheter is also inserted into the ruptured stent

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Figure 6: Stent removal is successfully performed, and the new plastic stent is also placed

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This adverse event may be critical, and fine gauge balloon catheter is useful not only as dilation but also reintervention device.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
DhirV, IsayamaH, ItoiT, etal. Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc 2017;29:472-85.  Back to cited text no. 1
    
2.
TybergA, SharaihaRZ, KediaP, etal. EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: Amulticenter international collaborative study. Gastrointest Endosc 2017;85:164-9.  Back to cited text no. 2
    
3.
ItoiT, YasudaI, KuriharaT, etal. Technique of endoscopic ultrasonography-guided pancreatic duct intervention(with videos). J Hepatobiliary Pancreat Sci 2014;21:E4-9.  Back to cited text no. 3
    
4.
Fujii-LauLL, LevyMJ. Endoscopic ultrasound-guided pancreatic duct drainage. J Hepatobiliary Pancreat Sci 2015;22:51-7.  Back to cited text no. 4
    
5.
ItoiT, SofuniA, TsuchiyaT, etal. Initial evaluation of a new plastic pancreatic duct stent for endoscopic ultrasonography-guided placement. Endoscopy 2015;47:462-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

 
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