A Rare Complication of ERCP: Duodenal Perforation Due to Biliary Stent Migration

Abstract

Placement of pancreatobiliary stents during endoscopic retrograde cholangiopancreatography (ERCP) is a common practice. Stents can be used for management of various entities, including malignant biliary strictures, large obstructing bile duct or pancreatic duct stone burden, benign biliary or pancreatic duct strictures, bile leak, papillary stenosis, pseudocyst drainage, and prevention of post-ERCP pancreatitis. Migration of a biliary stent is a known potential complication of ERCP, with distal migration occurring in 4 % to 6 % of cases [1,2].Perforation of the duodenal wall opposing the major papilla due to a migrated pancreatobiliary stent has been described previously in the literature as a complication of ERCPnearly universally in case reports [3][4][5][6][7][8][9][10][11][12][13][14][15]. From all accounts, it is a rare complication, yet the adverse outcome from a duodenal perforation can be devastating. Factors associated with perforation from migrated stents are unknown. Furthermore, the incidence rate of this complication is also not currently appreciated.The primary aims of this study were to describe cases of duodenal perforation from migrated pancreatobiliary stents and to identify potential risk factors that may lead to perforation.

Duodenal perforation secondary to stent migration after ERCP for hepatobiliary tuberculosis: Case report of a lethal complication in a young patient

“…Similar cases were reported in a retrospective observational study by Gromski et al, where in six cases of duodenal perforation involving biliary stents were reported after endoscopic retrograde cholangiopancreatography for both benign and malignant cases [7] . The mean age was 65.2 years, 4 of the procedures were performed for malignant biliary obstruction, and plastic biliary stents were used in 6 cases.…”

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][13][14][15]. Endoscopic closure was successful in all 13 cases, and OTSC closure was considered safer than clip closure.…”

“…However, gastrointestinal penetration or transmural perforation due to stent migration is rare, with an incidence of < 1% [4]. 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][6][7][8][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][11][12][13][14].…”

“…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][6][7][8][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][11][12][13][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.…”