A rare complication of ERCP: duodenal perforation due to biliary stent migration

Abstract Background and study aims Perforation of the duodenal wall opposing the major papilla due to a migrated pancreatobiliary stent rarely has been described in the literature as a complication of endoscopic retrograde cholangiopancreatography (ERCP). Factors associated with perforation from migrated stents from ERCP are unknown. Patients and methods This was a retrospective, observational study. Patients were identified from January 1, 1994 to May 31, 2019 in a prospectively maintained ERCP database. Results Eleven cases of duodenal perforation from migrated pancreatobiliary stents placed at ERCP were identified during the study period. All cases involved biliary stents, placed for biliary stricture management. The perforating stent was plastic in 10 cases (91 %). This complication occurred in one in 2,293 ERCP procedures in which a pancreatobiliary stent was placed. Conclusion This complication is more common with biliary stents compared to pancreatic stents. This may be related to the angle of exit of biliary stents being more perpendicular to the opposing duodenal wall and the near exclusive use of external pigtail plastic stents in the pancreatic duct. All perforating plastic stents were ≥ 9 cm in length. Longer stents may provide leverage for perforation with a migration event.

Download Full-text

Biliary Stent Migration Causing Simultaneous Duodenal and Distal Ileal Perforation: A Rare Complication

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v18i2.619 ◽

2020 ◽

Vol 18 (2) ◽

Author(s):

Rajeev Shamsuddin Perisamy

Keyword(s):

Biliary Obstruction ◽

Case Reports ◽

Rare Complication ◽

Invasive Procedure ◽

Stent Migration ◽

Duodenal Perforation ◽

Minimally Invasive Procedure ◽

Biliary Stenting ◽

Endoscopic Retrograde ◽

Ileal Perforation

Introduction: Endoscopic retrograde cholangiogram pancreatography (ERCP) and biliary stenting is a minimally invasive procedure widely utilised to relieve biliary obstruction. Although not common, it is related with several possible complications. Stent migration causing duodenal perforation is 1 of its rare complications as being described in several previous case reports. However up to date there is no case report on migrated stent with subsequent duodenal and distal ileal perforation as will be discussed here. Importance of radiological examinations and its related findings in diagnosing this very rare complication will be described in this article.

Download Full-text

Complications due to Biliary Stent Deviation

Austin Journal of Gastroenterology ◽

10.26420/austinjgastroenterol.2021.1112 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Kinoshita Kumar ◽

◽

Fukuchi S ◽

Murakami K ◽

◽

...

Keyword(s):

Computed Tomography ◽

Endoscopic Sphincterotomy ◽

Clinical Symptoms ◽

Acute Cholangitis ◽

Biliary Stent ◽

Plastic Stents ◽

Duodenal Perforation ◽

Early Complications ◽

Biliary Stents ◽

Uterine Appendage

We often encounter complications from biliary stents used as a treatment for obstructive jaundice and acute cholangitis. Early complications after stent placement include pancreatitis, bleeding, and duodenal perforation [1]. Stent deviation is also a complication. This is particularly prominent for plastic stents, where stent deviation is observed in 6-18.7 % of cases [2]. Stent deviation is more common among patients who have undergone endoscopic sphincterotomy (Figure 1). Most deviated biliary plastic stents are excreted in stool or collected endoscopically, but, very rarely, complications causing gastrointestinal perforation have been reported. We have described deviated biliary plastic stents causing sigmoid colon diverticulum perforation and even uterine appendage penetration (Figure 2). Diagnosis can be made from clinical symptoms and abdominal computed tomography. Treatment is basically surgery. Biliary stent-related complications are inevitable, and sometimes become serious. On suspicion of such complications, the most important issue is to accurately and rapidly diagnose complications and conduct appropriate management.

Download Full-text

Outcomes of Endoscopic Stenting for Traumatic Biliary and Pancreatic Fistulae

The American Surgeon ◽

10.1177/000313481608200723 ◽

2016 ◽

Vol 82 (7) ◽

pp. 588-593

Author(s):

John S. Richey ◽

Benjamin M. Manning ◽

Wesley B. Jones

Keyword(s):

Biliary Stricture ◽

Patient Characteristics ◽

Pancreatic Injury ◽

Endoscopic Stenting ◽

Biliary Stents ◽

Endoscopic Retrograde ◽

Included Patient ◽

The Mean ◽

High Output

The role of endoscopic retrograde cholangiopancreatography (ERCP) in the trauma patient is limited. Therefore, reporting of outcomes is sparse in the literature. The purpose of this study was to review outcomes of patients who underwent ERCP for traumatic biliopancreatic injury. We retrospectively reviewed 1550 ERCPs, from a prospectively maintained database, performed by a single surgical endoscopist consulted by the trauma surgical service for the management of traumatic fistulae. Referral was made for patients with high output (greater than 200 mL/d) and/or persistent (failure to resolve within 30 days) fistulae and traumatic biliary stricture. Primary end point was postprocedural complications. Secondary end points included patient characteristics, stents placed, and duration of stenting. Seventeen patients underwent a total of 31 ERCPs for biliary and/or pancreatic injury resulting from abdominal trauma (eight penetrating, nine blunt). Fourteen patients had ERCP after laparotomy, with a mean interval to ERCP of 74 days. In three patients, ERCP was the only intervention required. Fourteen biliary stents were placed, seven of which were metallic. Ten pancreatic stents were placed; one proximally migrated but was successfully retrieved. Four patients had both ducts simultaneously stented. The mean duration of stenting was 158 days. All fistulae resolved after stenting. There were no serious complications.

Download Full-text

Endoscopic transpapillary gallbladder stenting using a newly designed plastic stent for acute cholecystitis

Endoscopy International Open ◽

10.1055/a-0747-5668 ◽

2019 ◽

Vol 07 (09) ◽

pp. E1105-E1114 ◽

Cited By ~ 3

Author(s):

Kazunari Nakahara ◽

Yosuke Michikawa ◽

Ryo Morita ◽

Keigo Suetani ◽

Nozomi Morita ◽

...

Keyword(s):

Acute Cholecystitis ◽

Clinical Success ◽

Stent Migration ◽

Sufficient Evidence ◽

Plastic Stents ◽

Control Group ◽

The Novel ◽

Stent Group ◽

Biliary Stents ◽

Plastic Stent

Abstract Background and study aims Biliary plastic stents are generally substituted for gallbladder stents in endoscopic transpapillary gallbladder stenting (EGBS), there is no sufficient evidence about what type of plastic stent is suitable. We examined outcomes of EGBS using standard biliary stents and a novel stent for acute cholecystitis and evaluated the efficacy of the novel stent. Patients and methods Seventy patients with acute cholecystitis in whom EGBS was performed were evaluated retrospectively. We performed EGBS in 23 patients using the novel stent (novel stent group) and 47 patients using standard biliary stents (pigtail: 35, straight: 12) (control group). In the two groups, we examined outcomes of EGBS. Results There were no significant differences in patient backgrounds or rates of technical success, clinical success, or early adverse events (AE) between the novel stent group and the control groups. However, rates of late AEs were 4.3 % in the novel stent group (liver abscess: 1) and 40.4 % in the control group (stent migration: 15, recurrence of cholecystitis: 4), indicating a significantly higher rate in the control group (P = 0.004). The rate of stent migration was significantly higher in the control group (P = 0.006). Multivariate analysis identified a straight type stent as the risk factor for stent migration (odds ratio: 8.81, 95 % confidence interval: 1.66 – 46.83). Conclusions The novel stent had significantly lower rates of late AEs and stent migration. Thus, for long-term stent placement, the novel stent was more effective than traditional biliary stents.

Download Full-text

A Rare Complication of Biliary Stent Migration: Small Bowel Perforation in a Patient with Incisional Hernia

Case Reports in Surgery ◽

10.1155/2015/860286 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Özkan Yilmaz ◽

Remzi Kiziltan ◽

Oktay Aydin ◽

Vedat Bayrak ◽

Çetin Kotan

Keyword(s):

Incisional Hernia ◽

Intestinal Tract ◽

Rare Complication ◽

Bowel Perforation ◽

Stent Migration ◽

Biliary Stent ◽

Small Bowel Perforation ◽

Malignant Diseases ◽

Biliary Stents ◽

Pass Through

Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia.

Download Full-text

Endoscopic management of duodenal perforations caused by migrated biliary plastic stents

Endoscopy International Open ◽

10.1055/a-0887-4200 ◽

2019 ◽

Vol 07 (06) ◽

pp. E792-E795 ◽

Cited By ~ 5

Author(s):

Shin Hee Kim ◽

Jong Ho Moon ◽

Yun Nah Lee ◽

Tae Hoon Lee ◽

Sang Myung Woo ◽

...

Keyword(s):

Stent Migration ◽

Plastic Stents ◽

Endoscopic Management ◽

Duodenal Perforation ◽

Mortality And Morbidity ◽

Procedural Complication ◽

Life Threatening ◽

Stage Renal Disease ◽

End Stage ◽

Duodenal Perforations

Abstract Background and study aims Duodenal perforation by migration of plastic stents placed to treat biliary lesions is rare but can be life-threatening. Surgical management is preferred, but it may increase risks of mortality and morbidity, especially in patients with underlying comorbidities and those of advanced age. We describe five cases of duodenal perforation that were successfully managed endoscopically. Four patients were elderly, and one had end-stage renal disease. We used cylindrically adapted cap-fitted endoscopy to successfully retrieve migrated plastic stents and to close the perforated walls with hemoclips. No post-procedural complication was noted. In conclusion, endoscopic management is appropriate as a first-line approach in patients with duodenal perforations caused by plastic stent migration.

Download Full-text

Early Management Experience of Perforation after ERCP

Gastroenterology Research and Practice ◽

10.1155/2012/657418 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Guohua Li ◽

Youxiang Chen ◽

Xiaojiang Zhou ◽

Nonghua Lv

Keyword(s):

Conservative Treatment ◽

Early Phase ◽

Rare Complication ◽

Gastric Fundus ◽

Duodenal Perforation ◽

Endoscopic Retrograde ◽

Afferent Limb ◽

Early Management ◽

Endoscopic Nasobiliary Drainage ◽

Management Experience

Background and Aim. Perforation after endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it is associated with significant mortality. This study evaluated the early management experience of these perforations.Patients and Methods. Between November 2003 and December 2011, a total of 8504 ERCPs were performed at our regional endoscopy center. Sixteen perforations (0.45%) were identified and retrospectively reviewed.Results. Nine of these 16 patients with perforations were periampullary, 3 duodenal, 1 gastric fundus, and 3 patients had a perforation of an afferent limb of a Billroth II anastomosis. All patients with perforations were recognized during ERCP by X-ray and managed immediately. One patient with duodenal perforation and three patients with afferent limb perforation received surgery, others received medical conservative treatment which included suturing lesion, endoscopic nasobiliary drainage (ENBD), endoscopic retrograde pancreatic duct drainage (ERPD), gastrointestinal decompression, fasting, broad-spectrum antibiotics, and so on. All patients with perforation recovered successfully.Conclusions. We found that: (1) the diagnosis of perforation during ERCP may be easy, but you must pay attention to it. (2) Most retroperitoneal perforations can recover with only medical conservative treatment in early phase. (3) Most peritoneal perforations need surgery unless you can close the lesion up under endoscopy in early phase.

Download Full-text

Additional flap on plastic stents for improved antimigration effect in the treatment of post-cholecystectomy bile leak

Endoscopy International Open ◽

10.1055/s-0043-125361 ◽

2018 ◽

Vol 06 (04) ◽

pp. E489-E494

Author(s):

Chang-Il Kwon ◽

Mark Gromski ◽

Hyoung-Chul Oh ◽

Jeffrey Easler ◽

Ihab El Hajj ◽

...

Keyword(s):

Migration Rate ◽

Bile Leak ◽

Stent Migration ◽

Plastic Stents ◽

Biliary Duct ◽

Stent Insertion ◽

Biliary Stents ◽

Plastic Stent ◽

Total Failure ◽

Improved Performance

Abstract Background and study aims In plastic stent insertion for treatment of post-cholecystectomy bile leak, stent migration may be more common due to the absence of a shelf to anchor the stent. We evaluated how adding a flap to straight plastic stents for this indication might influence the rate of stent migration when compared to use of conventional plastic stents. Patients and methods This is a retrospective study including patients referred for ERCP for treatment of post-cholecystectomy bile leak. Patients with a customized anti-migration flap stent had the additional flap created on the distal end of straight plastic stents, intended to aid in anchoring in the distal supra-sphincteric biliary duct. The primary endpoint is stent migration events. The secondary endpoint is bile leak resolution after first ERCP session. Results Thirty-two patients were treated with the experimental additional flap stents and 225 patients were treated with standard straight biliary stents. The total failure rate of bile leak resolution after a single endoscopic treatment for all treated was 10.5 % (27/257) and the total stent migration rate for all enrolled was 15.2 % (39/257). Stent migration rate was lower in the additional flap stent group than in the conventional group (3.1 % vs. 16.9 %, respectively, P = 0.04). Furthermore, significantly more patients had resolution of their bile leak after the first ERCP session in the group with the additional flap (100 % vs. 88 %, respectively, P = 0.03). Conclusion A plastic biliary stent with an extra flap may have improved performance with regard to stent migration and resolution of bile leak over standard plastic biliary stents.

Download Full-text

A review of problems following insertion of biliary stents illustrated by an unusual complication

Annals of The Royal College of Surgeons of England ◽

10.1308/147870810x12659688852239 ◽

2010 ◽

Vol 92 (4) ◽

pp. e27-e31 ◽

Cited By ~ 14

Author(s):

Atul Bagul ◽

Cristina Pollard ◽

Ashley R Dennison

Keyword(s):

Case Reports ◽

Abdominal Sepsis ◽

Stent Migration ◽

Plastic Stents ◽

Unusual Complication ◽

Biliary Stents ◽

Left Groin ◽

Biliary Endoprosthesis ◽

Increased Risk ◽

Invasive Techniques

Introduction The management of obstructive jaundice resulting from both benign and malignant causes relies heavily on minimally invasive techniques and particularly with the insertion of biliary endoprostheses. Migration of these biliary stents is a well-documented problem and can result in a variety of complications including perforation, intra-abdominal sepsis, fistulae formation, obstruction and appendicitis. Methods A literature search was performed using PubMed examining case reports, published abstracts and reviews to date (2009). In addition, we report a left groin abscess as a previously unreported complication following migration of a biliary endoprosthesis. Findings Stent migration can lead to serious complications and produce significant morbidity and mortality. Symptomatic patients especially those with other co-morbid abdominal pathologies such as colonic diverticulae, parastomal hernia or abdominal hernias may be at an increased risk of perforation especially when straight plastic stents are used.

Download Full-text

Intraperitoneal duodenal perforation secondary to early migration of biliary stent: closure with through-the-scope clip

BMJ Case Reports ◽

10.1136/bcr-2019-230324 ◽

2019 ◽

Vol 12 (9) ◽

pp. e230324 ◽

Cited By ~ 3

Author(s):

Khaled Jadallah ◽

Bara Alzubi ◽

Aroob Sweidan ◽

Abdel R Almanasra

Keyword(s):

Stent Migration ◽

Duodenal Perforation ◽

Stent Insertion ◽

Biliary Stenting ◽

Biliary Stents ◽

Plastic Stent ◽

Early Migration ◽

Endoscopic Extraction ◽

Malignant Biliary Stricture ◽

Prompt Diagnosis

Endoscopic biliary stenting is a well-recognised method of palliation of malignant biliary obstruction. Distal stent migration causing duodenal perforation is an uncommon complication of this procedure and is usually delayed. Early stent migration resulting in duodenal perforation is extremely rare and can be easily overlooked. We present a case of stent migration and resultant intraperitoneal duodenal perforation that occurred 24 hours following plastic stent insertion for a malignant biliary stricture in a 63-year-old woman. The patient required emergent abdominal laparoscopy with the placement of intraperitoneal drain, followed by endoscopic extraction of the stent and closure of the defect using a through-the-scope clip. This case report addresses intraperitoneal duodenal perforation secondary to early migration of biliary stents. Special emphasis is placed on the importance of prompt diagnosis and the use of endoclips in the management of this serious complication of endoprosthesis.

Download Full-text