The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Acute Recurrent Pancreatitis Caused by Proximal Migration of a Prophylactic Pancreatic Stent

예방용 췌관 스텐트의 근위부 이탈로 인한 반복성 췌장염

  • Lee, Jae Kwang (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Myung-Hwan (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae June (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Ji Hoon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Gi Ae (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Minsoo (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon-Seok (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 이재광 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김명환 (울산대학교 의과대학 서울아산병원 내과) ;
  • 이재준 (울산대학교 의과대학 서울아산병원 내과) ;
  • 강지훈 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김기애 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김민수 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김준석 (울산대학교 의과대학 서울아산병원 내과)
  • Received : 2012.04.07
  • Accepted : 2012.05.31
  • Published : 2013.04.01
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Abstract

Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic pancreatic stents are effective for reducing the risk for post-ERCP pancreatitis in high-risk patients. However, an unretrieved pancreatic stent, as a result of proximal migration, can cause pancreatitis. We experienced a case of recurrent acute pancreatitis associated with a pancreatic ductal leak and stricture due to proximal migration of a prophylactic stent in a patient with suspected acute gallstone pancreatitis. We endoscopically retrieved the proximally migrated stent and inserted a new pancreatic stent. Follow-up pancreatic imaging showed that the pancreatitis and pancreatic ductal leak/stricture had resolved.

ERCP 시행과 연관된 췌장염 발생을 예방하고자, 고위험군에서 췌관 스텐트 삽입이 널리 이용되고 있다. 그러나 췌관 스텐트 삽입 후 췌관의 손상, 스텐트 폐색, 스텐트 이탈 등의 합병증이 발생할 수 있으며, 특히 췌관 스텐트의 근위부 이탈은 췌장염을 일으킬 수 있다. 저자들은 예방용 췌관 스텐트의 근위부 이탈로 인한 급성 재발성 췌장염 환자에서 내시경을 이용하여 스텐트를 회수하고 동반된 췌관 협착과 췌액 누출을 성공적으로 치료한 증례를 경험하였기에 이를 보고한다.

Keywords

References

  1. Freeman ML. Pancreatic stents for prevention of postendoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol 2007;5:1354-1365. https://doi.org/10.1016/j.cgh.2007.09.007
  2. Gan SI, Kozarek RA. Pancreatic endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 2012;44: 389-393. https://doi.org/10.1055/s-0031-1291872
  3. Price LH, Brandabur JJ, Kozarek RA, Gluck M, Traverso WL, Irani S. Good stents gone bad: endoscopic treatment of proximally migrated pancreatic duct stents. Gastrointest Endosc 2009;70:174-179. https://doi.org/10.1016/j.gie.2008.12.051
  4. Lahoti S, Catalano MF, Geenen JE, Schmalz MJ. Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center. Gastrointest Endosc 1998;47:486-491. https://doi.org/10.1016/S0016-5107(98)70249-4
  5. Seerden TC, Moreels TG, Salgado RA, et al. Intestinal bowel perforation and bacterial peritonitis secondary to migrated biliary and pancreatic stents. Endoscopy 2008; 40(Suppl 2):E25. https://doi.org/10.1055/s-2007-966961
  6. Horwhat JD, Jowell P, Branch S, Fleishman L, Gress FG. Proximal migration of a 3 French pancreatic stent in a patient with pancreas divisum: suggested technique for successful retrieval. JOP 2005;6:178-184.
  7. Johanson JF, Schmalz MJ, Geenen JE. Simple modification of a pancreatic duct stent to prevent proximal migration. Gastrointest Endosc 1993;39:62-64. https://doi.org/10.1016/S0016-5107(93)70013-9
  8. Yoon LY, Moon JH, Choi HJ, et al. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents after endoscopic papillectomy for ampullary adenoma. Gut Liver 2011;5:532-535. https://doi.org/10.5009/gnl.2011.5.4.532
  9. Kantsevoy SV, Frolova EA, Thuluvath PJ. Successful removal of the proximally migrated pancreatic winged stent by using the SpyGlass visualization system. Gastrointest Endosc 2010;72:454-455. https://doi.org/10.1016/j.gie.2009.11.029
  10. Baron TH, Dean LS, Morgan DE, Holt TL. Proximal migration of a pancreatic duct stent: endoscopic retrieval using interventional cardiology accessories. Gastrointest Endosc 1999;50:124-125. https://doi.org/10.1016/S0016-5107(99)70363-9