Raguraj Chandradevan, MD, Amit Hudgi, MD, Ria Callednder, BS, Skyler Baker, BS, Subbaramiah Sridhar, MD Augusta University, Augusta, GA Introduction: Johlin plastic stents are tapered pancreatic duct (PD) stents with sideholes & without flanges are frequently used in endoscopic management of pancreatic duct (PD) strictures. However, stents without flanges are prone to proximal migration, especially during tandem stenting. We describe a novel technique employing hemostatic clips (Hemoclips) successfully to prevent proximal migration of PD stents.
Case Description/
Methods: Cases: A 58-year-old male with PD strictures & stones required a 10 Fr. 14 cm Johlin stent which had migrated proximally which was removed with a snare. He presented for a repeat ERCP and placement of two 10 Fr. 12 cm Johlin stent. The stents threatened to migrate proximally. 70-year-old female with PD strictures & fusiform dilatation & pancreatic parenchymal calcification had an ERCP and placement of a 10 Fr. 14 cm Johlin PD stent. A repeat ERCP was performed for the removal and placement of an new 10 Fr., 14 cm Johlin stent which threatened to migrate proximally during the procedure. A 50-year-old male with PD strictures & multiple prior plastic stents had a repeat ERCP. He required a 10 Fr., 16 cm Johlin stent. An 80-year-old male with PD stricture, stones & prior proximal stent migration presented for repeat ERCP. A 10 Fr., 14 cm Johlin stent was placed.
Procedure: The ERCP procedures were performed under general anesthesia, all were administered with rectal indomethacin. The previously placed stents were removed intact with snare. The main PD were accessed with a 12 mm occlusion balloon or an 0.025 sphincterotome, and an 0.025” angled-tip guidewire. PD strictures or dilatation of the PD as mentioned were found. The PD strictures were dilated with balloon to 6 mm. followed by placement of a 10 Fr. Johlin stents. In our 1st and 2nd pt the stents threatened to migrate proximally. Two Hemoclips were then placed at right angles to the externally visible tip of the stents on all patients to prevent proximal migration by forming a “barricade” effect. Fluoroscopy confirmed stable stent position before the scope withdrawal. Discussion: Flanged stents are typically preferred to prevent migration, however, stents without flanges (Johlin stents) offer advantages for its ease of placement but are prone to migration. The stent sideholes facilitate duct drainage. The described “barricade technique,” by Hemoclips to anchor the plastic PD stents provide a practical method to prevent proximal stent migration when using stents without flanges.
Figure: Endoscopic view of T Bolting
Figure: Fluoroscopic view of T bolting
Disclosures: Raguraj Chandradevan indicated no relevant financial relationships. Amit Hudgi indicated no relevant financial relationships. Ria Callednder indicated no relevant financial relationships. Skyler Baker indicated no relevant financial relationships. Subbaramiah Sridhar indicated no relevant financial relationships.
Raguraj Chandradevan, MD, Amit Hudgi, MD, Ria Callednder, BS, Skyler Baker, BS, Subbaramiah Sridhar, MD. P0231 - T Bolting for Proximal Stent Migration, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
