Post written by Koichi Soga, MD, PhD, from the Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, and the Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan.

Endoscopic transpapillary biliary stents (EBSs) are offered in a variety of types, including endoscopic plastic and metal stents, with a variety of techniques for placement. As for endoscopic biliary decompression, endoscopic transpapillary biliary stenting is a commonly performed procedure that includes 2 methods of placement: stenting above the major papilla (suprapapillary) and stenting across the major papilla (transpapillary).

Occlusion of EBSs can occur because of several factors. Among them, direct food impaction, biofilm formation, and sludge formation play important roles. Thus, endoscopic inside stent placement is presumed to be theoretically overcome by EBSs above the major papilla.

I believe that a similar mechanism to the EBS problem may occur with endoscopic transpapillary pancreatic stents (EPSs), and I applied this concept for endoscopic inside pancreatic plastic stents (IPPSs) in the case of the pancreatic duct occlusion in this study.

Before placement of an IPPS into the pancreatic duct, I confirmed endoscopically that the EPS was obstructed by food residue at the duodenal side. To overcome the EPS occlusion, I was reminded of the concept of IPPSs.

After this procedure, the patient was able to perform the planned preoperative chemotherapy and scheduled IPPS replacement. Then, scheduled surgical procedures were performed without problems.

The usefulness of the inside biliary stent has been proven for biliary disease. I considered that IPPSs may be applied to pancreatic stricture disease.

To the best of my knowledge, this case report is the first regarding the use of IPPSs for drainage of the main pancreatic duct. I would expect that IPPSs can be successfully applied in clinical practice to reduce pancreatic duct stenting problems.

My report is based on only 1 case, and I believe that further accumulation of cases is needed to demonstrate the usefulness of IPPSs.

Graphical abstract

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