Supplementary Material for: Migration of a common bile duct stone into the main pancreatic duct due to catheter manipulation during endoscopic retrograde cholangiopancreatography

Introduction: We report the first case of a choledocholithiasis migrating into the main pancreatic duct (MPD) due to catheter manipulation during endoscopic retrograde cholangiopancreatography (ERCP). Case Presentation: A 57-year-old woman complaining of vomiting was diagnosed with acute cholangitis and pancreatitis due to choledocholithiasis. During ERCP, the stone migrated from the papilla into the MPD due to the pushing motion of the catheter. However, the ERCP session was completed after biliary sphincterotomy without intervention in the MPD because the migration was not noticed. The migrated stone became apparent on computed tomography the following day. The second ERCP revealed the stone measuring 5 mm in the MPD. After pancreatic sphincterotomy, a pancreatic stent with was placed, which improved the obstructive pancreatitis. Conclusion: Endoscopists performing ERCP should be aware of this rare but serious complication.

引言：本文报道首例内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）术中导管操作导致胆总管结石（choledocholithiasis）迁移入主胰管（main pancreatic duct, MPD）的病例。病例报告：1例57岁女性因呕吐就诊，被诊断为胆总管结石引发的急性胆管炎及胰腺炎。内镜逆行胰胆管造影术（ERCP）术中，因导管推挤操作，结石从十二指肠乳头迁移至主胰管（MPD）。因未察觉结石迁移，术者仅完成胆管括约肌切开术，未对主胰管进行干预。术后次日的计算机断层扫描（computed tomography, CT）发现了迁移的结石。第二次ERCP检查显示主胰管（MPD）内存在一枚直径5mm的结石。行胰管括约肌切开术后，置入胰管支架，梗阻性胰腺炎得以改善。结论：开展ERCP操作的内镜医师需警惕这一罕见但严重的并发症。