TriHealth is a unified health system based in Cincinnati, Ohio, United States. It was originally formed in 1995. Currently the system comprises four hospitals: Bethesda North, Good Samaritan, Bethesda Butler, and TriHealth Evendale Hospital. TriHealth's non-hospital services include physician practice management, fitness centers, occupational health centers, home health and hospice care. TriHealth is one of the largest employers in greater Cincinnati with over 11,000 employees.
Proximal migration of pancreatic duct (PD) stents is an uncommon but technically challenging adverse event of endoscopic therapy, particularly in patients with chronic pancreatitis complicated by ductal strictures and intraductal stones. We report a case of successful retrieval using pancreatoscopy-guided electrohydraulic lithotripsy (EHL) after failure of conventional endoscopic techniques. A 79-year-old man with chronic calcific pancreatitis underwent Endoscopic retrograde cholangiopancreatography (ERCP) for PD stent removal, during retrieval attempts the stent migrated proximally. Standard retrieval methods, including balloon and basket extraction, were unsuccessful due to a mid-duct stricture and impacted stones. Pancreatoscopy revealed the stent embedded within a fibrotic segment surrounded by dense calculi. EHL was performed to fragment the stones, followed by balloon dilation of the stricture. A snare was then advanced under direct visualization, allowing successful stent retrieval. A new PD stent was placed with good drainage and no adverse events. Pancreatoscopy-guided EHL offers an effective minimally invasive solution for complex PD stent retrieval.
