Bowel perforation: a ‘not so rare’ complication of biliary stent migration

Brown, Damien; Naidu, Jeevinesh; Thomas, Rebecca

doi:10.1111/ans.16902

Cited by 3 publications

References 16 publications

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Bowel Perforation Caused by Biliary Stent Migration After ERCP

Wilson,

Ezeani,

Ismail

et al. 2024

Journal of Clinical Gastroenterology

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Goals: This systematic review aims to evaluate the risk factors, clinical features, and outcomes of bowel perforation caused by stent migration after endoscopic retrograde cholangiopancreatography (ERCP). Background: Distal migration of biliary stents can occur after ERCP. Upon migration, most stents pass through the intestine without adverse events; however, bowel perforation has been reported. Study: A comprehensive literature search of PubMed, EMBASE, and Cochrane databases was conducted through October 2023 for articles that reported bowel perforation because of stent migration. Cases of incomplete stent migration and proximal stent migration were excluded. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify full-length articles in English reporting. Results: Of 2041 articles retrieved on the initial search, 92 met the inclusion criteria. A total of 132 cases of bowel perforation occurred due to stent migration after ERCP (56.1% female; average age: 66 y). The median time from initial ERCP to perforation was 44.5 days (IQR 12.5–125.5). Most cases of perforation occurred in the small bowel (64.4%) compared with the colon (34.8%). Stents were mostly plastic (87.1%) with a median diameter of 10 Fr (IQR 8.5–10) and median length of 10.3 cm (IQR 715). Surgical management was pursued in 52.3% and endoscopic management in 42.4%. Bowel resection was required for 25.8% of patients. The overall mortality rate was 17.4%. Conclusion: In summary, this study demonstrates that bowel perforation after ERCP stent migration primarily occurs within 44.5 days and most frequently with a 10 Fr plastic biliary stent. The overall mortality rate was 17.4%. It is important for endoscopists to be mindful of this rare but serious adverse event.

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Bowel Perforation Caused by Biliary Stent Migration After ERCP

Wilson,

Ezeani,

Ismail

et al. 2024

Journal of Clinical Gastroenterology

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Re: Bowel perforation: a ‘not so rare’ complication of biliary stent migration

Yagnik¹,

Garg

2022

ANZ Journal of Surgery

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Re: Bowel perforation: a 'not so rare' complication of biliary stent migration Dear Editor, We read with great interest an article entitled: Bowel perforation: a 'not so rare' complication of biliary stent migration by Brown et al. recently published in your esteemed journal. 1 It is indeed a rare case series. We would like to congratulate the authors for reporting such unusual cases. We have a few comments regarding the article that you may find pertinent.In the series presented by the authors, we noted that all the stents were straight plastic biliary stents. In addition, in table 1, only case number 1 had pigtail and straight both stents, but on checking the original report, we found that migrated stent was straight biliary stent. 2 From the available literature, Yagnik et al. (2018) observed that most reported cases of luminal perforation with biliary stents had been associated with a straight biliary stent. Therefore, they suggest that double pigtail stents are used to prevent such perforation and migration as pigtail stents are less likely to migrate distally. 3 They are placed slightly differently than straight stents. 3 Authors had also mentioned that early cholecystectomy followed by removal of plastic stents within 3 months of insertion should be instituted as per European Society of Gastrointestinal Endoscopy (ESGE) recommendations. 4 However, this recommendation may not be worth preventing migration and perforation as, in the present series, all the cases perforation was developed before 3 months. We suggest the following advice given by Yagnik et al. to use a double pigtail stent instead of a straight stent to prevent such disastrous complication. 3

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Management Of Foreign Bodies In The Gastrointestinal Tract: A Retrospective Study Of 24 Cases

Guo

Zhang

Xue

et al. 2022

Preprint

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Background: Foreign body ingestion is frequently encountered in clinical practice. However, few studies have focused on gastrointestinal foreign body ingestion. This study aims to analyze the location of gastrointestinal foreign body ingestion and treatment measures to report our experience in its management. Methods: Data were collected from all patients with foreign body ingestion accepting management in our center from September 2016 to July 2022. The demographic data, type, location, clinical features, and management were reviewed and analyzed retrospectively. Results: A total of 24 cases with foreign body ingestion underwent management. Jujube pit ingestion was the most common (16 cases). Most of the ingested foreign bodies were located in the intestine (21 cases), especially in the small intestine (7 cases). One case in the duodenum and one in the rectum underwent conservative management, 3 cases in the stomach and 2 cases in the intestine underwent endoscopic treatment, and 17 cases in the intestine underwent surgical intervention. Conclusions: Ingested foreign body is usually secondary to unconscious accidental ingestion and is frequently caused by dietary habits. Foreign body ingestion in the GI tract usually happens in the small intestine with perforation-peritonitis. Once foreign body ingestion is diagnosed, it must be decided on therapeutic regimens based on the location of foreign body.

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Bowel perforation: a ‘not so rare’ complication of biliary stent migration

Cited by 3 publications

References 16 publications

Bowel Perforation Caused by Biliary Stent Migration After ERCP

Bowel Perforation Caused by Biliary Stent Migration After ERCP

Re: Bowel perforation: a ‘not so rare’ complication of biliary stent migration

Management Of Foreign Bodies In The Gastrointestinal Tract: A Retrospective Study Of 24 Cases

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