Successful removal of the proximally migrated pancreatic winged stent by using the Spy Glass visualization system

A 40-year-old female presented with frequent (every 2-3 weeks) attacks of pancreatitis (abdominal pain, vomiting, elevation of amylase and lipase). ERCP demonstrated narrow opening of the main pancreatic duct, barely letting a guidewire through. Pancreatic sphincterotomy was performed and a 5F 5-cm-long single pigtail pancreatic winged stent (ViaDuct; GI Supply, Camp Hill, PA) was inserted into the main pancreatic duct (Fig. 1). The patient was discharged with improvement. She had no complaints for 6 weeks but then developed another episode of pancreatitis. Repeat ERCP revealed stent migration deep into the pancreas, with the proximal end of the stent now located at the end of the main pancreatic duct (Fig. 2). Attempts to retrieve the stent with various accessories (snares, baskets, and balloons) were not successful. The patient was discharged home on intravenous total parenteral nutrition. However, 3 weeks later she again developed severe attack of pancreatitis. ERCP was repeated, and once again the attempts to retrieve the stent with snares, baskets, and balloons could not move the stem from its position deep inside the pancreas. At this point, SpyGlass visualization system (Boston Scientific, Natick, MA) was introduced into the pancreatic duct (Fig. 3). Evaluation with the SpyGlass revealed that the pigtail of the stent had migrated into a side branch of the pancreatic duct (Fig. 4). The pigtail end of the stent was grabbed by its side wings with the SpyBite forceps (Boston Scientific) and was pulled out of the side branch into the main pancreatic duct. Then the stent was grabbed en face with the SpyBite forceps and removed (Fig. 5). After the stent removal, the episode of pancreatitis resolved and the patient was discharged home in a stable condition.