Novel biopsy forceps removed pancreatic duct foreign bodies in disconnected pancreatic duct syndrome via endoscopic ultrasound-guided pancreatic duct drainage fistula

Abstract

Figures

ERCP was attempted and the guidewire was unable to access the distal pancreatic duct. Abbreviation: ERCP.

Endoscopic ultrasound-guided puncture of the pancreatic duct was performed and a double pig tail stent was successfully inserted between the pancreatic duct and the gastric wall.

a The guide wire was inserted into the EUS-PD sinus. b, c A double pigtail stent and a single pigtail stent were again inserted into the sinus to dilate the sinus. Abbreviation: EUS-PD, endoscopic pancreatic duct drainage.

A guide wire was inserted into the sinus and a peroral pancreatoscopy was applied to explore the pancreatic duct.

The residual guide wire was removed by a new type of biopsy forceps under the direct vision of peroral pancreatoscopy.

Full text

A middle-aged woman with disconnected pancreatic duct syndrome due to necrotizing pancreatitis. The patient was admitted to a local hospital with recurrent pancreatitis. The patient underwent endoscopic pancreatic duct drainage (EUS-PD) treatment in an external hospital, but unfortunately, it failed and the guide wire was “fractured,” and the broken end of the guide wire remained in the pancreatic duct. The patient was referred to our hospital, where ERCP was tried, but the guide wire was never able to enter the distal pancreatic duct ( Fig. 1 ). EUS-PD was then performed and a stent was placed between the pancreatic duct and the gastric wall ( Fig. 2 ). The patient returned to our center 3 months after discharge, and a double pigtail stent and a single pigtail stent were re-inserted through the EUS-PD sinus to dilate the sinus ( Fig. 3 ). Three months later, the patient returned to the clinic. After the stent was removed, a peroral pancreatoscopy was inserted into the sinus, and the residual guide wire was removed with novel biopsy forceps (SpyBite Max, Boston Scientific corporation) under direct vision ( Fig. 4 , Fig. 5 , Video 1 ). A stent was placed between the pancreatic duct and the stomach wall and removed 2 months after surgery. No special discomfort was found in the patients during 6-month follow-up.

ERCP was attempted and the guidewire was unable to access the distal pancreatic duct. Abbreviation: ERCP.

Endoscopic ultrasound-guided puncture of the pancreatic duct was performed and a double pig tail stent was successfully inserted between the pancreatic duct and the gastric wall.

a The guide wire was inserted into the EUS-PD sinus. b, c A double pigtail stent and a single pigtail stent were again inserted into the sinus to dilate the sinus. Abbreviation: EUS-PD, endoscopic pancreatic duct drainage.

A guide wire was inserted into the sinus and a peroral pancreatoscopy was applied to explore the pancreatic duct.

The residual guide wire was removed by a new type of biopsy forceps under the direct vision of peroral pancreatoscopy.

A new type of biopsy forceps was used to remove pancreatic duct foreign bodies with disconnected pancreatic duct syndrome through EUS-PD fistula under the direct vision of peroral pancreatoscopy.Video 1

The phenomenon of “fractured” usually occurs in the operation of complex pancreatic diseases such as pancreatic duct stenosis and disconnected pancreatic duct syndrome 1 2 3 . In our case, the patient had pancreatic duct dissociation syndrome, and ERCP was unable to enter the distal pancreatic duct. We established the sinus canal by EUS-PD and gradually implanted multiple stents to dilate the sinus canal. Then, a new type of biopsy forceps was used to remove the broken guide wire in the pancreatic duct under the direct vision of peroral pancreatoscopy.

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