Pancreatoscopy-Guided Retrieval of a Migrated Stent Using a Novel Thin Pancreatoscope in a Patient with Roux-en-Y Gastrectomy

A case description Pancreatic duct (PD) stent placement can be performed to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) [ 1​ ]. However, stent migration may also occur after PD stent placement. Although the endoscopic retrieval of migrated PD stents has been widely reported [ 2​ ] [ ​3​ ], retrieval in patients with Roux-en-Y gastrectomy under balloon enteroscopy is considered particularly challenging. Recently, a novel thin cholangiopancreatoscope (eyeMAX; Micro-Tech, China), with a length of 219 cm and a diameter of 9-Fr ([ Fig. 1 ]), has enabled cholangiopancreatoscopy-guided interventions to be performed using a balloon enteroscope [ 4​ ]. We report a case of successful pancreatoscopy-guided retrieval of a migrated stent using a novel thin pancreatoscope under balloon enteroscopy in a patient with Roux-en-Y gastrectomy. Fig. 1 A thin cholangiopancreatoscope (eyeMAX; Micro-Tech, China) measuring 219 cm in length and 9-Fr in diameter. A 62-year-old woman with common bile duct stones, who had previously undergone Roux-en-Y gastrectomy, was referred to our institution ([ Fig. 2 ]). ERCP was performed using a short-type single-balloon enteroscope (SIF-H290; Olympus Marketing, Japan) with a working length of 152 cm and a 3.2-mm working channel [ 5​ ]. As only pancreatic duct cannulation was achieved, the double-guidewire technique and transpancreatic biliary sphincterotomy were performed; however, selective biliary cannulation was not achieved ([ Fig. 3 ]). Therefore, the 5-Fr PD stent was placed to prevent PEP. However, stent migration occurred during the procedure ([ Fig. 4 ]). Because the fluoroscopy-guided stent retrieval was considered challenging under balloon enteroscopy, pancreatoscopy-guided stent retrieval was attempted using a novel thin pancreatoscope ([ Video 1 ]). The migrated stent was clearly visualized under pancreatoscopy ([ Fig. 5a ]). Therefore, we attempted to retrieve the stent using biopsy forceps that could be passed through the thin pancreatoscope. The distal end of the stent was successfully grasped under direct pancreatoscopic visualization ([ Fig. 5b, c ]), and the stent was successfully retrieved ([ Fig. 5d ]). Fig. 2 Computed tomography revealing multiple stones in the common bile duct (red arrow). Fig 3 Endoscopic and fluoroscopic findings. (a and b) Only pancreatic duct cannulation was achieved. (c and d) Transpancreatic biliary sphincterotomy was performed; however, selective biliary cannulation was not achieved. Fig. 4 Endoscopic and fluoroscopic findings revealing the plastic stent migrated into the bile duct (red arrow). Video 1 Successful pancreatoscopy-guided retrieval of a migrated stent using a novel thin cholangioscope under a balloon enteroscope in a patient with Roux-en-Y gastrectomy. Download Video Fig. 5 Pancreatoscopic and endoscopic findings for stent retrieval. ( a ). Pancreatoscopy revealing the migrated stent in the pancreatic duct. ( b and c ) The distal end of the stent was successfully grasped under direct pancreatoscopic visualization. ( d ). Endoscopic finding revealing the successful stent retrieval of a migrated stent. This case highlights that pancreatoscopy-guided retrieval using a novel thin pancreatoscope under balloon enteroscopy may be an effective option for managing migrated PD stents in such cases. Endoscopy_UCTN_Code_TTT_1AR_2AK Publication History Received: 23 April 2026 Accepted: 25 May 2026 Article published online: 12 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany