P0186 - Management of Severe Pancreatic Ductal Stricture with a Soehendra Stent Retriever

Zarak H. Khan, MD¹, Karissa Lambert, MD², Prashant Mudireddy, MD^2
1East Carolina University, Greenville, NC; ²East Carolina Gastroenterology, Greenville, NC

Introduction: Pancreatic ductal strictures are a common complication of chronic pancreatitis. Management is done with dilation and placement of different types of stents including plastic or metallic stents. The soehendra stent retriever (SSR) is similar to a screw drill and has several applications including dilation of biliary strictures, pancreatic pseudocyst drainage, dilation of post-liver transplant anastomotic structure etc. Here we present a case of pancreatic ductal stricture dilated with a SSR.

Case Description/Methods: Patient is a 66-year-old female known case of DM- 2, HTN, hyperlipidemia, smoking, and chronic calcific pancreatitis complicated by pseudocyst in the setting of alcohol use disorder who presented for an outpatient ERCP procedure for pancreatic stricture intervention. Patient endorsed long term epigastric abdominal pain and diarrhea. Previously, an ERCP was performed with unsuccessful attempt at deep pancreatic ductal cannulation. An EUS guided rendezvous procedure was also performed at that time and the pancreatic duct was accessed through the stomach wall. Contrast was injected and a severe stricture was found at the neck of the pancreas. Multiple attempts to advance the wire across the stricture into the second part of the duodenum were unsuccessful. This time several additional attempts were made to access the pancreatic duct which were unsuccessful. Eventually, a Soehendra stent retriever (Image 1) was used, and the stricture was successfully traversed. The stricture was then dilated to 4 mm followed by a plastic pigtail stent placement (Image 2) to drain the pancreatic duct.

Discussion: Pancreatic duct strictures pose a complicated medical problem that requires a multi-disciplinary management approach. The SSR can be a very useful option to use for severe pancreatic duct strictures that could not be managed with conventional ERCP and EUS guided ductal drainage.



Disclosures:


Zarak H. Khan, MD¹, Karissa Lambert, MD², Prashant Mudireddy, MD². P0186 - Management of Severe Pancreatic Ductal Stricture with a Soehendra Stent Retriever, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.