the most serious complication of endoscopic papillectomy ( ep ) for ampullary adenoma is postprocedure severe pancreatitis . many studies suggest that the prophylactic placement of a pancreatic duct ( pd ) stent after ep reduces the risk of pancreatitis.1,2 however , proximal migration of the pd stent occurs at a rate of about 5.2%.3 in general , ep is performed for ampullary adenoma not extending into the biliary or pancreatic duct . therefore , endoscopic retrieval of proximally migrated pd stents after ep is difficult because the pd diameter is within the normal range in most cases . we describe a case series with proximally migrated pd stents after ep that were retrieved successfully using a wireguided endoscopic snare . between july 2004 and june 2009 , we attempted endoscopic removal of proximally migrated pd stents after ep for ampullary adenoma in 5 patients . all patients underwent prophylactic placement of a pd stent after ep to reduce the risk of postprocedure pancreatitis . wire - guided endoscopic snare retrieval was attempted in four patients and the conventional method using a forceps , snare , or basket without a guidewire in one patient . the pd is cannulated using an endoscopic retrograde cholangiopancreatography ( ercp ) catheter and then a 0.035-inch guidewire is inserted deeply through the catheter . after removing the ercp catheter , a snare ( sd-7p-1 or sd-8p-1 ; olympus , tokyo , japan ) is passed over the guidewire . the migrated stent is captured in the snare and removed via traction on the snare . if the first attempt of capturing the migrated stent at its distal end was not successful , it was then tried at its proximal end . after the excision was completed , a 5 fr , 9-cm geenen pd stent ( wilson - cook , winston - salem , nc , usa ) was placed immediately and positioned across the pd orifice ( fig . after retrieving the resected specimen , the pd stent was not seen in the duodenum . unfortunately , the stent could not be retrieved because pd cannulation is difficult consequent to the edema and oozing that occurs after ep . the patient was kept fasting overnight and an attempt to retrieve the pd stent was made the next day . due to the small diameter of the pd , it was difficult to pass accessories alongside the stent for its retrieval . after the excision was completed , a 5 fr , 7-cm geenen pd stent was placed immediately . after retrieving the resected specimen , we made several attempts to retrieve the stent , although the pd orifice was not seen clearly due to edema . the next day , we performed wire - guided endoscopic snare retrieval of the pd stent successfully ( fig . after the excision was completed , a 5 fr , 9-cm geenen pd stent was inserted . the next day , the plain abdominal radiograph confirmed that the stent had migrated into the proximal pd . endoscopic retrieval of the stent was not attempted because the patient refused follow - up endoscopy to remove the stent . then , wire - guided endoscopic snare retrieval of the pd stent was performed successfully . after the excision was completed , a 5 fr , 5-cm geenen pd stent was inserted . the next day , the plain abdominal radiograph showed that the stent had migrated proximally . the migrated stent was removed successfully using the wire - guided endoscopic snare method and no procedure - related complications occurred . a 34-year - old asymptomatic man was found to have an ampullary adenoma with a normal biliopancreatic duct on ercp . ep was performed using a reported method.4,5 after the excision was completed , a 5 fr , 9-cm geenen pd stent was placed immediately and the distal end protruded into the duodenum . after taking up the resected specimen , the pd stent was not seen in the duodenum . several attempts to retrieve the stent via the papillae using a rat - tooth forceps , snare , or basket were unsuccessful . the next day the migrated stent was removed successfully with a minisnare ( soft acusnare ; wilson - cook ) . unfortunately , the patient developed severe pancreatitis and required hospitalization for 1 month to recover from the postprocedure pancreatitis . after the excision was completed , a 5 fr , 9-cm geenen pd stent ( wilson - cook , winston - salem , nc , usa ) was placed immediately and positioned across the pd orifice ( fig . after retrieving the resected specimen , the pd stent was not seen in the duodenum . unfortunately , the stent could not be retrieved because pd cannulation is difficult consequent to the edema and oozing that occurs after ep . the patient was kept fasting overnight and an attempt to retrieve the pd stent was made the next day . due to the small diameter of the pd , it was difficult to pass accessories alongside the stent for its retrieval . after the excision was completed , a 5 fr , 7-cm geenen pd stent was placed immediately . after retrieving the resected specimen , we made several attempts to retrieve the stent , although the pd orifice was not seen clearly due to edema . the next day , we performed wire - guided endoscopic snare retrieval of the pd stent successfully ( fig . a 63-year - old man underwent ep for ampullary adenoma . after the excision was completed , the next day , the plain abdominal radiograph confirmed that the stent had migrated into the proximal pd . endoscopic retrieval of the stent was not attempted because the patient refused follow - up endoscopy to remove the stent . then , wire - guided endoscopic snare retrieval of the pd stent was performed successfully . a 56-year - old woman underwent ep for ampullary adenoma . after the excision was completed , the next day , the plain abdominal radiograph showed that the stent had migrated proximally . the migrated stent was removed successfully using the wire - guided endoscopic snare method and no procedure - related complications occurred . a 34-year - old asymptomatic man was found to have an ampullary adenoma with a normal biliopancreatic duct on ercp . ep was performed using a reported method.4,5 after the excision was completed , a 5 fr , 9-cm geenen pd stent was placed immediately and the distal end protruded into the duodenum . after taking up the resected specimen , the pd stent was not seen in the duodenum . fluoroscopy confirmed that the stent had migrated into the proximal duct . several attempts to retrieve the stent via the papillae using a rat - tooth forceps , snare , or the migrated stent was removed successfully with a minisnare ( soft acusnare ; wilson - cook ) . unfortunately , the patient developed severe pancreatitis and required hospitalization for 1 month to recover from the postprocedure pancreatitis . many studies suggest that placement of a pd stent reduces the risk of pancreatitis after ep.1,2,4,6 - 9 with the increasing use of pd stents , many complications can occur , including migration of the stent . proximal migration may be more serious because of the technical challenge associated with the attempt at retrieval . in one report , proximal stent migration occurred in 5.2% of patients and the majority of these stents could be retrieved endoscopically.3 lahoti et al.10 reported a successful endoscopic retrieval rate of 80% ( 8 of 10 ) . of the two patients in whom the stents could not be retrieved , one developed continuous pain and required a distal pancreatectomy for stent removal . a recent retrospective study of 33 patients involving endoscopic treatment of proximally migrated pancreatic stents reported a successful retrieval rate of 78% for endoscopically placed stents.11 the stents were retrieved using a balloon ( 44% ) , direct forceps grasp ( 28% ) , and guidewire stent cannulation with snare capture ( 11% ) . four patients underwent surgery and one asymptomatic patient was observed . unfortunately , endoscopic treatment of proximally migrated pd stents after ep is more difficult due to the small diameter of the pd and postprocedure periampullary edema and bleeding . in previous reports , the rate of post - ercp pancreatitis was higher when cannulation was difficult and prolonged.12,13 multiple attempts at retrieval of a pd stent may predispose to pancreatitis owing to the added mechanical trauma . therefore , a safe effective method for retrieving the migrated pd stent is needed to reduce postprocedure pancreatitis . cannulation of the nondilated main pd can be difficult using the accessories required for migrated stent retrieval . therefore , we initially cannulate the pd with a catheter and then place a guidewire . after removing the ercp catheter , , we attempted to retrieve the proximally migrated pd stent immediately after ep in two patients . although the migrated stent was retrieved 1 day later , one patient developed severe pancreatitis , which was difficult to treat , and the other developed mild pancreatitis . in the other patients , stent retrieval was attempted between 1 day and 2 weeks after placement . these three patients did not develop acute pancreatitis . from this perspective , it may be better to delay retrieving a proximally migrated stent because pancreatic duct cannulation immediately after ep is difficult due to edema and bleeding . if a stent has to be retrieved for a variety of reasons , such as pancreatitis or abdominal pain , further study of the optimal timing of retrieval is needed . in conclusion , wire - guided endoscopic snare retrieval of proximally migrated pd stents after ep is safe and effective . in our experience , it is better to delay retrieval of a migrated stent by at least 1 day . however , further studies are needed to determine effective methods and optimal timing for the retrieval of proximally migrated pd stents after ep .