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Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
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Which stent to pull?

13/4/2021

 
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Patient has turned up to have his 'green' PD stent removed but I'm astounded to find two stents poking out of the papilla and they are both green !?
WHAT SHOULD I DO?
■ Remove the stent with a twist in it
Turned out to be correct!
■ Remove the straight stent
Nope!
■ Remove both stents
A dangerous attitude?
explanation
After scrutinising the X-rays, I concluded that the Pancreatic Duct stent was the 'single pig-tailed' stent (the one with the twist). Furthermore, the other one was draining bile. Obviously, the reason for the pig-tail is to stop the stent from migrating up the duct. PD stents are more likely to migrate than CBD stents and therefore the pig-tailed stent was more likely to be the PD stent even before I confirmed this on the images taken at the time of ERCP. 

Well, this is one of the reasons why I don't like having stent removals on my list. Shouldn't it be the job of the person who placed to stent to also remove them?! 

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