Endoscopic ultrasound-guided pancreaticogastrostomy to facilitate retrieval of a proximally migrated pancreatic duct stent in a post-Whipple patient: a case report.

Proximal migration of a pancreatic duct (PD) stent is a rare but challenging adverse event. This case describes an effective approach for retrieving a migrated PD stent. A 70-year-old man after Whipple surgery presented with recurrent pancreatitis. Computed tomography revealed a dilated PD, a pancreaticojejunal anastomotic stricture, and an internally migrated PD stent. A staged approach was initiated with endoscopic ultrasound-guided pancreaticogastrostomy and placement of a plastic pancreatic stent, which was then upsized to a fully covered self-expandable metal stent. Pancreatoscopy was used to visualize and retrieve the migrated stent. Balloon dilation of the pancreaticojejunal stricture was performed, followed by placement of a plastic pancreatic stent. The migrated stent was successfully retrieved, and the patient remained asymptomatic without recurrent pancreatitis. This case demonstrated that endoscopic ultrasound-guided pancreaticogastrostomy and stepwise dilation are an effective approach for pancreatoscopy and retrieval of a migrated PD stent in patients with altered anatomy.