The retrieval of complex foreign bodies lodged deep within the pancreatic and biliary ducts (PBDs) often constitutes a high-risk procedure, frequently necessitating surgical intervention when conventional methods fail. The primary aim of this case presentation is to validate and demonstrate the decisive therapeutic benefit and safety profile of cholangioscopy/pancreatoscopy-assisted ERCP for the extraction of highly challenging, proximally migrated foreign objects. This work supports the establishment of advanced endoscopic techniques as the definitive, non-surgical first-line treatment in specialized endoscopy centers.

We present two illustrative clinical cases requiring advanced endoscopic visualization and retrieval:

1. Case 1 (Pancreatic Duct : A female patient presented with right upper quadrant pain indicating complications from a proximally migrated prophylactic pancreatic stent, which had moved deep into the pancreatic tail. Due to the deep position and technical challenges of the migrated stent, the extraction required direct visualization via SpyGlass Pancreatoscopy. The retrieval was successfully accomplished using SpyBite Biopsy Forceps under real-time endoscopic guidance, as standard techniques were rendered ineffective.
2. Case 2 (Biliary Duct): A complex case involving a patient with a history of complicated open cholecystectomy. The patient suffered from recurrent, severe episodes of cholangitis and associated symptoms. Imaging confirmed the presence of an inadvertent surgical foreign body—a protective drainage tube—which had been retained within the Ductus Choledochus (common bile duct). Definitive management was achieved via ERCP guided by SpyGlass Cholangioscopy, allowing for the precise targeting and safe removal of the intra-choledochal drain.

Both procedures were performed to eliminate the necessity for high-morbidity surgical exploration.

The endoscopic procedures achieved a 100% technical success rate for the complete retrieval of both complex foreign bodies.  Crucially, both patients successfully avoided major surgery, demonstrating the profound clinical impact of the technology. Both individuals were managed minimally invasively, leading to rapid recovery and discharge within 48 hours without major post-ERCP complications.

The successful management of a deeply migrated pancreatic stent and a surgically retained biliary drain, both previously challenging indications, underscores the decisive role of cholangioscopy/pancreatoscopy-assisted ERCP. The integration of direct visualization and specialized tools significantly expands the therapeutic reach of endoscopy. This strategy is established as the first-line definitive therapy for complex pancreatobiliary foreign body extraction, significantly reducing patient morbidity and accelerating convalescence by eliminating the need for surgical intervention.