Migration of a self-expandable metallic stent into a drained pseudocyst after endoscopic pseudocystogastrostomy and its endoscopic extraction

Czech version

Authors: M. Štěpán ¹; O. Urban ^2,3,4; P. Fojtík ¹; P. Falt ^1,3,4
Authors‘ workplace: Centrum péče o zažívací trakt, Vítkovická nemocnice, a. s., Ostrava ¹; II. interní klinika – gastroenterologická a hepatologická LF UP a FN Olomouc ²; LF OU v Ostravě ³; LF UK v Hradci Králové ⁴
Published in: Gastroent Hepatol 2018; 72(3): 221-224
Category:
doi: https://doi.org/10.14735/amgh2018221

Overview

Pancreatic pseudocysts and walled-off pancreatic necrosis are local complications of acute and chronic pancreatitis. Their treatment, if indicated, consists of percutaneous, surgical or endoscopic drainage. In recent years, the increasingly preferred option is endoscopic ultrasound-guided transmural drainage for fluid collection. A relatively rare complication is the migration of an introduced stent after endoscopic drainage. We present a 52-year-old patient with chronic pancreatitis and a symptomatic pseudocyst, for which treatment by endoscopic pseudocystogastrostomy with a fully covered self-expanding metal stent was complicated by the development of a pneumoperitoneum. After surgical revision, the presence of an originally introduced stent in the residual pseudocyst was detected by imaging techniques and was subsequently successfully extracted by endoscopy through the newly introduced metallic stent.

Key words:
pancreatic pseudocyst – endoscopic ultrasound-guided transmural drainage – fully covered self-expanding metalic stent – stent migration

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted: 15. 3. 2018

Accepted: 24. 4. 2018

Sources

1. Andrašina T, Bohatá Š. Zobrazovací metody u akutní pankreatitidy. In: Trna J, Kala Z. Klinická pankreatologie. 1. vyd. Praha: Mladá fronta 2016: 43–54.

2. Banks PA, Bollen TL, Dervenis C et al. Classification of acute pankreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62 (1): 102–111. doi: 10.1136/gutjnl-2012-302 779.

3. Chung IH, Kim HW, Lee DK. Endoscopic removal of a migrated cystogastrostomy double pigtail stent through a pancreatico-duodenal fistula tract. J Interv Gastroenterol 2011; 1 (3): 142–144. doi: 10.4161/jig.1.3.18515.

4. Singhal S, Rotman SR, Gaidhane M et al. Pancreatic fluid collection drainage by endoscopic ultrasound: an update. Clin Endosc 2013; 46 (5): 506–514. doi: 10.5946/ce.2013.46.5.5 06.

5. Lopes CV, Pesenti C, Bories E et al. Endoscopic-ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts and abscesses. Scand J Gastroenterol 2007; 42 (4): 524–529. doi: 10.1080/00365520601065 093.

6. Patil R, Ona MA, Papafragkakis C et al. Endoscopic ultrasound-guided placement of AXIOS stent for drainage of pancreatic fluid collections. Ann Gastroenterol 2016; 29 (2): 168–173. doi: 10.20524/aog.2016.0008.

7. Kliment M, Urban O, Fojtík P et al. Endoscopic drainage of pancreatic fluid collections – 6 years’ experience at a tertiary referral gastroenterological center in a period 2006–2012. Gastroent Hepatol 2017; 71 (3): 199–207. doi: 10.14735/amgh2017199.

8. Walter D, Vleggaar FP, Siersema PD. Self-expandable metal stents for endoscopic ultrasound-guided drainage of peripancreatic fluid collections. Gastrointest Interv 2013; 2 (1): 24–29. doi: 10.1016/j.gii.2013.01. 002.

9. Patrzyk M, Dierzek P, Glitsch A et al. Retrieval of a self-expanding metal stent after migration and incorporation in the omental bursa, using a gastroscopic-transgastric laparoscopic rendezvous technique. J Minim Access Surg 2015; 11 (3): 207–209. doi: 10.4103/0972-9941.147 365.

10. Lakhtakia S, Basha J, Nabi Z et al. Salvaging a malpositioned fully covered self-expanding metal stent for pancreatic fluid collection drainage. Endoscopy 2016; 48 (Suppl 1): E180–E181. doi: 10.1055/s-0042-106966.

11. Wang GX, Liu X, Wang S et al. Stent diplacement in endoscopic pancreatic pseudocyst drainage and endoscopic management. World J Gastroenterol 2015; 21 (7): 2249–2253. doi: 10.3748/wjg.v21.i7.2249.

12. Tarantino I, Di Pisa M, Barresi L et al. Covered self expandable metallic stent with flared plastic one inside for pancreatic pseudocyst avoiding stent dislodgement. World J Gastrointest Endosc 2012; 4 (4): 148–150. doi: 10.4253/wjge.v4.i4.148.