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.

The Pierced Colon: When Biliary Stents Go the Wrong Way

“…Colonic perforation is a rare complication of biliary stenting. Reviewing reported cases of colonic perforations of biliary stents from 2000 to 2022 (Table 1 ), we found that unlike in duodenal perforation, which carries a high risk of mortality, 6 , 7 mortality in reported cases of colonic perforation is low (1 of 32). Of note, only 1 perforation was confirmed to be due to a pigtail stent while 31 of 32 perforations were caused by straight stents (25 of 32) or the type of stent was not mentioned (5 of 32).…”

“…Although stent migration is not uncommon, serious complications due to this are rare. Duodenal perforation vis-à-vis of the papilla by straight biliary stents ranges from 1 in 2,293 6 to 2.1%. 7 The majority was managed with endoscopic removal and closure, with however high mortality (3 of 11 6 vs 4 of 13 cases 7 ).…”

“…Duodenal perforation vis-à-vis of the papilla by straight biliary stents ranges from 1 in 2,293 6 to 2.1%. 7 The majority was managed with endoscopic removal and closure, with however high mortality (3 of 11 6 vs 4 of 13 cases 7 ). While migration to unusual sites, such as the pericardium, 8 – 10 bronchial system, 11 and perforation of small bowel, 12 , 13 is limited to few case reports, colonic perforation has been reported in 32 cases since 2000 (Table 1 ), with only 5 cases outside the rectosigmoid colon, in which most perforations occurred because of impaction in thin-walled diverticula.…”

Successful endoscopic closure with an over-the-scope clip for sigmoid colon perforation due to bile duct stent migration

“…As shown in Table 1 , 13 cases, including our case, of endoscopic closure using an OTSC for gastrointestinal perforation due to bile duct stent migration have been reported thus far [ 6 , 12 – 15 ]. Endoscopic closure was successful in all 13 cases, and OTSC closure was considered safer than clip closure.…”

“…Perforation due to displacement of the biliary stent can occur mainly in the duodenum and in other parts of the small intestine and the colon [ 5 – 9 ]. In recent years, endoscopic closure of gastrointestinal perforations using an over-the-scope clip (OTSC) has been shown to be effective with a high success rate [ 6 , 10 – 14 ]. Here, we have reported a case of sigmoid colon perforation caused by a bile duct stent that was treated conservatively by endoscopic closure using an OTSC.…”