Pancreatic stent migration is a recognized complication of therapeutic endoscopy, often posing significant technical challenges for retrieval. Migrated stents can lead to ductal obstruction, pancreatitis, or infection if not removed promptly. While several endoscopic accessories are available, there is limited prospective data comparing their utility in real-world scenarios. The aim of this prospective study was to evaluate the feasibility, safety, and success of different endoscopic techniques for removal of migrated pancreatic stents in a small cohort of patients, highlighting the role of pancreatoscopy and adjunctive laser-assisted methods.

Between January 2024 and April 2025, eight consecutive patients presenting with migrated pancreatic stents were prospectively enrolled. Demographic data, clinical presentation, and procedural details were recorded. All procedures were performed under conscious sedation. 

A stepwise approach was adopted, beginning with conventional endoscopic accessories (rat tooth forceps, stone retrieval balloon, hurricane balloon, sohendra stent retrieval) and escalating to advanced Spy glass pancreatoscopy - guided methods (SpyBite max forceps, Spyglass retrieval snare, and laser-assisted fragmentation) when conventional techniques failed. Each patient’s final successful retrieval technique was documented. Procedural success was defined as complete removal of the migrated stent without need for surgical intervention.

The cohort consisted of seven male patients and one female patient, with ages ranging from 19 to 65 years (mean age 40.5 years). All eight patients underwent successful endoscopic removal of the migrated pancreatic stent. Conventional techniques were effective in three patients: one with rat tooth forceps and two with a stone retrieval balloon. In five patients, advanced Pancreatoscopy-guided methods were required. SpyGlass-guided retrieval combined with SpyBite max forceps was successful in one patient, while SpyGlass with laser fragmentation followed by Spyglass retrieval snare or SpyBite max forceps was required in four patients. Laser guided fragmentation of stent was performed in four patient as the ends of stent were impacted in the side branch.

No major complications such as perforation, severe bleeding, or pancreatitis were observed. Procedure times varied depending on technique, with mean procedure time was 75 minutes.

This prospective series demonstrates that while conventional accessories may suffice in select cases, migrated stents often necessitate advanced visualization and retrieval tools. The SpyGlass system, particularly when combined with laser fragmentation, provided enhanced ductal visualization and facilitated safe removal in complex scenarios.

This prospective series demonstrates that while conventional accessories may suffice in select cases, migrated stents often necessitate advanced visualization and retrieval tools. The SpyGlass system, particularly when combined with laser fragmentation, provided enhanced ductal visualization and facilitated safe removal in complex scenarios.