The “zipline” technique for endoscopic removal of a migrated pancreatic stent

Prophylactic placement of a pancreatic stent can reduce post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), but it entails the risk of several adverse events including stent migration [1]. Endoscopic removal of a migrated stent is technically challenging because limited devices are available for use in the small and tortuous pancreatic duct [2]. Here, we present a case in which the “zipline” technique enabled successful removal of a pancreatic stent that had totally migrated into the pancreatic duct. An 82-year-old man with a history of distal pancreatectomy underwent biliary stent placement for a biliary stricture due to eosinophilic cholangitis. During the initial ERCP session, a 5-Fr straighttype pancreatic stent was placed prophylactically. However, severe PEP occurred when the stent migrated into the pancreatic duct (▶Fig. 1, ▶Fig. 2). After the patient was referred to our department, we first attempted to remove the migrated stent with biopsy forceps 2 alongside the guidewire, but this failed. Additional attempts with over-the-wire devices such as a snare and a tapered balloon catheter were unsuccessful even though the guidewire was inserted through the migrated stent. Finally, the “zipline” E-Videos