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Wilson N, Ezeani C, Ismail A, Abdalla M, Mohammed S, Abdalla A, Elawad A, Beran A, Jaber F, Abosheaishaa H, Loon E, Abdallah M, Vargo J, Bilal M, Chahal P. Bowel Perforation Caused by Biliary Stent Migration After ERCP: A Systematic Review. J Clin Gastroenterol 2025; 59:472-478. [PMID: 39008570 DOI: 10.1097/mcg.0000000000002029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/05/2024] [Indexed: 07/17/2024]
Abstract
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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Affiliation(s)
- Natalie Wilson
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Chukwunonso Ezeani
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA
| | - Abdellatif Ismail
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD
| | - Monzer Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL
| | | | - Abubaker Abdalla
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Ayman Elawad
- Department of Internal Medicine, Howard University Hospital, Washington, DC
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO
| | | | - Erica Loon
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Mohamed Abdallah
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH
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Orsini-Ardengh A, Orsini-Arman AC, Haueisen Figueiredo Zwetkoff B, Micelli-Neto O, Surjan RCT, Ardengh JC. Conservative Treatment of Sigmoid Diverticulum Perforation Secondary to Migrated Biliary Plastic Prostheses Inserted by Endoscopic Retrograde Cholangiopancreatography: A Case Report of an Unusual Adverse Event and Literature Review. Cureus 2025; 17:e79042. [PMID: 40099079 PMCID: PMC11913399 DOI: 10.7759/cureus.79042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2025] [Indexed: 03/19/2025] Open
Abstract
Distal migration of biliary plastic stents is rare. Although these stents are primarily used in the treatment of benign diseases of the biliopancreatic tract, their distal migration can lead to severe complications, such as perforation of any part of the digestive system. The authors report a case of sigmoid diverticulum perforation caused by the migration of a biliary plastic stent, which had been initially placed due to a failure to extract a common bile duct (CBD) stone. A review of similar cases in the literature was conducted, and the findings were analyzed in relation to the reported case. The search was performed in MEDLINE and the Cochrane Library, covering studies published between 1975 and 2025. Only studies describing the placement of biliary plastic stents during endoscopic retrograde cholangiopancreatography (ERCP) were included, while studies with incomplete data were excluded. This study highlights this rare and serious complication, which carries a high morbidity rate. Despite careful stent positioning during ERCP and periodic follow-up, this adverse event (AE) cannot always be prevented. Although distal stent migration with perforation can often be treated endoscopically, preoperative evaluation of the patient's clinical condition and precise localization of the perforation is crucial for successful endoscopic stent removal, thus avoiding the need for surgery.
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Affiliation(s)
- André Orsini-Ardengh
- Gastrointestinal Endoscopy, Hospital Das Clínicas da Faculdade De Medicina da Universidade De São Paulo, São Paulo, BRA
| | | | | | | | - Rodrigo Cañada T Surjan
- Surgery, Faculdade De Medicina da Universidade De São Paulo, São Paulo, BRA
- Surgery, Hospital Nove De Julho, Diagnósticos da América S.A., São Paulo, BRA
| | - Jose C Ardengh
- Gastrointestinal Endoscopy, Hospital Das Clínicas De Ribeirão Preto, Ribeirão Preto, BRA
- Image Diagnosis, Universidade Federal De São Paulo, São Paulo, BRA
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Park TY, Hong SW, Oh HC, Do JH. Colonic diverticular perforation by a migrated biliary stent: A case report with literature review. Medicine (Baltimore) 2021; 100:e28392. [PMID: 34967373 PMCID: PMC8718208 DOI: 10.1097/md.0000000000028392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature. PATIENTS CONCERNS A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago. DIAGNOSES Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis. INTERVENTIONS Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed. OUTCOMES On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications. LESSONS Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.
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Affiliation(s)
- Tae Young Park
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Hong
- Department of General Surgery, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Hyoung-Chul Oh
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyuk Do
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Self-Expanding Metallic Stent Fracture in the Treatment of Malignant Biliary Obstruction. Gastroenterol Res Pract 2018; 2018:6527879. [PMID: 29849597 PMCID: PMC5914116 DOI: 10.1155/2018/6527879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 01/14/2023] Open
Abstract
Background Palliative therapies for malignant biliary obstruction (MBO) include choledochojejunostomy and self-expanding metallic stent (SEMS) insertion. Fractures following SEMS insertion in MBO treatment are scarce. Objective To assess the clinical features of biliary stent fractures and evaluate associated factors. Methods One hundred fifty-six consecutive patients who underwent biliary SEMS placement for MBO treatment at Beijing Chaoyang Hospital affiliated to Capital Medical University, in 2010–2015, were evaluated retrospectively. Demographics, clinical features, stent parameters and patency times, and survival times were collected. Across the ampulla of Vater, balloon dilatation, number of stents, stent patency time, and survival time were compared between the stent and nonstent fracture groups. Results There were 168 biliary metallic stents inserted in 156 patients, including 144 and 12 patients with one and 2-3 stents, respectively. Pre- and/or postballoon dilation was performed in 107 patients. Stents across and above the duodenal papilla were used in 105 and 51 patients, respectively. Six cases (3.8%) with stent occlusion had stent fractures. Single- and multiple-stent fracture rates were 4/144 (2.8%) and 2/12 (16.7%), respectively. Fracture times after stent deployment were 126.8 ± 79.0 (median, 115.5) days. Stent patency times in the stent and nonstent fracture groups were 151.8 ± 67.8 (median, 160.5) days and 159.3 ± 73.6 (median, 165.5) days, respectively. Overall survival times in the stent and nonstent fracture groups were 399.7 ± 147.6 (median, 364.0) days and 283.7 ± 126.1 (median, 289.0) days, respectively. Conclusion Stent fractures following MBO treatment constitute a relatively rare long-term complication. Though there were no factors found to be significantly associated with SEMSs fracture, a trend could be observed towards more fractures in multistent, transpapillary, and balloon dilation groups.
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Young Bang J, Coté GA. Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Issa H, Nahawi M, Bseiso B, Al-Salem A. Migration of a biliary stent causing duodenal perforation and biliary peritonitis. World J Gastrointest Endosc 2013; 5:523-526. [PMID: 24147198 PMCID: PMC3797907 DOI: 10.4253/wjge.v5.i10.523] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/08/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.
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Kittappa K, Maruthachalam K, Brookstein R, Debrah S. Migrated biliary stent presenting as a sigmoid diverticulitis-case report. Indian J Surg 2012; 75:253-4. [PMID: 24426582 DOI: 10.1007/s12262-012-0663-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 06/21/2012] [Indexed: 11/28/2022] Open
Abstract
This is a case report of a patient with biliary stent migration resulting in sigmoid diverticulum perforation. We report the case of a patient who presented with symptoms of diverticulitis 18 months following biliary stent insertion for bile leak following laparoscopic cholecystectomy. This rare complication of biliary stent placement should be included in differential diagnosis of any patient that presents with lower quadrant abdominal pain after endoscopic retrograde cholangiopancreatography (ERCP) with stent placement.
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Affiliation(s)
- Karthik Kittappa
- Department of Surgery, Royal Preston Hospital, Preston, PR2 9HT UK
| | | | - Roger Brookstein
- Department of General Surgery, Darlington Memorial Hospital, Darlington, UK DL3 6HX
| | - Samuel Debrah
- Department of General Surgery, Darlington Memorial Hospital, Darlington, UK DL3 6HX
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Papadopoulou I, Fotiadis NI, Ahmed I, Thurley P, Hutchins RR, Fotheringham T. Perforation and abscess formation after radiological placement of a retrievable plastic biliary stent. J Med Case Rep 2011; 5:103. [PMID: 21401933 PMCID: PMC3068103 DOI: 10.1186/1752-1947-5-103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 03/14/2011] [Indexed: 01/15/2023] Open
Abstract
Introduction Retrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting. Case presentation A 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week. Conclusion Late retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.
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Affiliation(s)
- Ioanna Papadopoulou
- Department of Diagnostic Imaging, Barts and The London NHS Trust, The Royal London Hospital, London, E1 1BB, UK.
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Saad WEA. Percutaneous transhepatic techniques for removal of endoscopically placed biliary plastic endoprostheses. Tech Vasc Interv Radiol 2008; 11:120-32. [PMID: 18922457 DOI: 10.1053/j.tvir.2008.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Endoscopic retrograde cholangiopancreatography-placed plastic biliary endoprostheses can migrate proximally and become impacted (4.9%). Endoscopy is resorted to first and percutaneous transhepatic techniques are resorted to second. Percutaneous transhepatic techniques are resorted to in probably less that 0.5% of all endoscopic retrograde cholangiopancreatography-placed plastic biliary endoprostheses and are rarely reported. The current article reviews the results, various techniques, and potential complications during the percutaneous transhepatic removal of these endoprostheses.
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Senosiáin M, Senent C, Nogales O, Hernando A, González Asanza C, Menchén P. [Sigmoid perforation secondary to spontaneous migration of a plastic biliary prosthesis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:317. [PMID: 18448064 DOI: 10.1157/13119886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Namdar T, Raffel AM, Topp SA, Namdar L, Alldinger I, Schmitt M, Knoefel WT, Eisenberger CF. Complications and treatment of migrated biliary endoprostheses: A review of the literature. World J Gastroenterol 2007; 13:5397-9. [PMID: 17879415 PMCID: PMC4171335 DOI: 10.3748/wjg.v13.i40.5397] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 mo. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.
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Affiliation(s)
- Thomas Namdar
- Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University, Moorenstrasse 5, Dusseldorf 40225, Germany.
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Sanyal A, Maskell GF, Hohle R, Murray IA. An unusual complication of oesophageal stent deployment. Br J Radiol 2006; 79:e103-5. [PMID: 16940361 DOI: 10.1259/bjr/66364821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Insertion of a self-expanding metal stent is commonly used to palliate dysphagia secondary to oesophageal carcinoma. Displacement of the stent itself is a recognized complication which can result in perforation of the upper gastrointestinal tract. We report the first case of bowel obstruction and perforation resulting from the olive of the deployment system. This was probably due to peritoneal deposits on the small intestine obstructing passage of the olive.
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Affiliation(s)
- A Sanyal
- Department of Gastroenterology, Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK
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Yoshida H, Mamada Y, Taniai N, Mizuguchi Y, Shimizu T, Aimoto T, Nakamura Y, Nomura T, Yokomuro S, Arima Y, Uchida E, Misawa H, Uchida E, Tajiri T. Fracture of an expandable metallic stent placed for biliary obstruction due to common bile duct carcinoma. J NIPPON MED SCH 2006; 73:164-8. [PMID: 16790985 DOI: 10.1272/jnms.73.164] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report our second case of fracture of a SMART self-expandable metallic stent (Cordis Endovascular, Warren, NJ) placed to treat biliary obstruction due to an unresectable common bile duct carcinoma. An 82-year-old man presented with jaundice. Computed tomography and ultrasonography on admission demonstrated a mass in the lower common bile duct. The mass was identified as a common bile duct obstruction. A SMART stent was inserted. Ten months after stent insertion, two additional SMART stents were inserted to relieve obstructive jaundice due to occlusion of the first stent. Fourteen months after insertion of the first stent, endoscopic examination revealed stenosis of the duodenum due to invasion of the common bile duct carcinoma, prompting us to perform a gastrojejunostomy 1 month later. Three months after gastrojejunostomy, the patient presented with obstructive jaundice and cholangitis. A fracture of one of the stents was then discovered on plain X-ray films and percutaneous transhepatic cholangiography. Two SMART stents were inserted simultaneously. In conclusion, we report the fracture of a SMART stent placed for common bile duct carcinoma. Fracture should be considered as a possible complication after metallic stent insertion.
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Affiliation(s)
- Hiroshi Yoshida
- Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
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Anderson EM, Phillips-Hughes J, Chapman R. Sigmoid colonic perforation and pelvic abscess complicating biliary stent migration. ACTA ACUST UNITED AC 2006; 32:317-9. [PMID: 16944034 DOI: 10.1007/s00261-006-9067-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Accepted: 06/20/2006] [Indexed: 11/30/2022]
Abstract
Endoscopically placed biliary stents are a well-established procedure for the treatment of benign and malignant causes of obstructive jaundice in patients unfit for definitive surgical intervention. Stent migration has been described, though in most instances the stent will pass or remain in the bowel lumen for extended periods of time. Only a few cases of clinically significant complications of stent migration have been reported. This is the first case report of a pelvic abscess complicating stenting for choledocholithiasis. As the numbers of stenting procedures continue to increase it may be anticipated that the numbers of complications will similarly increase.
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Yoshida H, Mamada Y, Taniai N, Mizuguchi Y, Shimizu T, Yokomuro S, Aimoto T, Nakamura Y, Uchida E, Arima Y, Watanabe M, Uchida E, Tajiri T. One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent. World J Gastroenterol 2006; 12:2423-6. [PMID: 16688837 PMCID: PMC4088082 DOI: 10.3748/wjg.v12.i15.2423] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies.
METHODS: Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure.
RESULTS: One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min. The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered.
CONCLUSIONS: One-step percutaneous transhepatic insertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient’s quality of life.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Surgery 1, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
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Re: Displacement of Endoscopically Placed Plastic Biliary Endoprostheses into the Duodenum with a Simple Transhepatic Technique—Reply. J Vasc Interv Radiol 2005. [DOI: 10.1097/01.rvi.0000173048.68762.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Brown KT, Schubert J, Covey AM, Brody LA, Sofocleous CT, Getrajdman GI. Displacement of Endoscopically Placed Plastic Biliary Endoprostheses into the Duodenum with a Simple Transhepatic Technique. J Vasc Interv Radiol 2004; 15:1139-43. [PMID: 15466802 DOI: 10.1097/01.rvi.0000136292.23500.0a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The authors to describe the technique and report the results of percutaneous displacement of endoscopically placed plastic biliary endoprostheses into the duodenum at the time of transhepatic intervention in 34 patients. Displacement into the duodenum was effected by simply passing a guide wire through the stent, and then pushing it into the gut with a catheter. Thirty-three of 36 stents (92%) were successfully displaced in this manner. No complications related to stent passage out of the gastrointestinal tract were encountered. Plastic biliary stents can be safely displaced into the duodenum when patients undergo transhepatic biliary procedures, thus avoiding repeated endoscopy.
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Affiliation(s)
- Karen T Brown
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
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Yoshida H, Tajiri T, Mamada Y, Taniai N, Kawano Y, Mizuguchi Y, Arima Y, Uchida E, Misawa H. Fracture of a biliary expandable metallic stent. Gastrointest Endosc 2004; 60:655-8. [PMID: 15472703 DOI: 10.1016/s0016-5107(04)01884-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Hiroshi Yoshida
- First Department of Surgery, Nippon Medical School, Tokyo, Japan
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Affiliation(s)
- Michael Elliott
- Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia.
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Basile A, Macri' A, Lamberto S, Caloggero S, Versaci A, Famulari C. Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent. Gastrointest Endosc 2003; 57:136-8. [PMID: 12518156 DOI: 10.1067/mge.2003.37] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cerisoli C, Diez J, Giménez M, Oria M, Pardo R, Pujato M. Implantation of migrated biliary stents in the digestive tract. HPB (Oxford) 2003; 5:180-2. [PMID: 18332981 PMCID: PMC2020584 DOI: 10.1080/13651820310015301] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary stents constitute an alternative for the palliative treatment of benign or malignant biliary obstruction, biliary strictures, choledocholithiasis, biliary fistulas from lateral lesions of the biliary duct or cystic duct leaks due to slippage of clip closure. Obstruction resulting in cholangitis is common. Proximal migration to the biliary duct or distal migration to the duodenum with subsequent passage per rectum are relatively frequent, but impaction and perforation of the bowel are rare. CASE OUTLINES Two cases are reported. In one patient a migrated stent impacted in the caecal wall, and in the other the impaction produced a perforation of an adherent small bowel loop. Both patients were treated surgically and made an uneventful recovery. DISCUSSION Biliary stents migrate in 8-10% of patients and are generally eliminated by natural means. Occasionally they impact and perforate the digestive tract, usually in the duodenum or other fixed areas or in bowel affected by adhesions due to a previous operation. Although endoscopy is the treatment of choice to retrieve them, operation should be performed whenever there is suspicion of perforation of the intestinal wall.
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Affiliation(s)
- C Cerisoli
- Instituto del CallaoBuenos AiresArgentina
| | - J Diez
- Division of Gastrointestinal Surgery, Hospital de Clinicas, University HospitalBuenos AiresArgentina
| | - M Giménez
- Department of Surgery, Hospital A RoffoBuenos AiresArgentina
| | - M Oria
- Department of General Surgery, Division of Laparoscopic Surgery, Hospital de Clinicas, University HospitalBuenos AiresArgentina
| | - R Pardo
- Salvador UniversityBuenos AiresArgentina
| | - M Pujato
- Instituto Argentino de Diagnostico y TratamientoArgentina
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Fotheringham T, Abbass S, Varghese JC, Haslam P, Lyon S, Lee MJ. Displacement of occluded plastic endoprostheses into the duodenum during percutaneous biliary drainage: description of an under-reported technique. Clin Radiol 2002; 57:1113-7. [PMID: 12475537 DOI: 10.1053/crad.2002.1115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Percutaneous transhepatic biliary drainage (PTBD) is occasionally requested in patients with an occluded plastic stent in situ. We describe a technique for dislodging the stent into the duodenum during PTBD. MATERIALS AND METHODS Twelve patients (M:F, 9:3 mean age 70 years) with plastic stents in the common bile duct (CBD) underwent PTBD. Eleven patients had malignant obstruction and one patient had Mirizzi's syndrome and a large duodenal diverticulum. PTBD was performed using right lobe access in nine patients and a left hepatic access in three patients. The level of biliary obstruction was at the lower CBD in five patients, mid-CBD in four patients and upper CBD in three patients. After standard percutaneous biliary access was established, an 8mm by 4 cm balloon catheter was gently inflated alongside the upper end of the plastic stent and advanced over a stiff guidewire, towards the duodenum, to dislodge the plastic stent. RESULTS Plastic stents were successfully dislodged in all 11 patients with malignancy and metallic stents were deployed for palliation. In nine of 11 patients with malignant lesions the PTBD dislodgement of the plastic stent and insertion of a metallic stent was carried out as a single-step procedure. In two patients with biliary sepsis, a two-step procedure was necessary. In the patient with Mirizzi's syndrome the plastic stent could not be dislodged. No complications were observed. CONCLUSION Plastic stents, inserted at ERCP, can be dislodged in the majority of cases at PTBD using a balloon catheter inserted alongside the failed stent without complication.
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Affiliation(s)
- T Fotheringham
- Radiology Department, Royal London Hospital, Whitechapel, London, UK
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23
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Figueiras RG, Echart MO, Figueiras AG, González GP. Colocutaneous fistula relating to the migration of a biliary stent. Eur J Gastroenterol Hepatol 2001; 13:1251-3. [PMID: 11711785 DOI: 10.1097/00042737-200110000-00021] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The endoscopic placement of endoprostheses to decompress biliary obstruction is a commonly used treatment for malignant biliary diseases and is also used in the treatment of benign biliary strictures. Complications of endoprosthesis placement have been described and include the migration of the stent. We present a case of a colonic-cutaneous fistula secondary to the migration of a plastic biliary stent with colonic perforation.
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Affiliation(s)
- R G Figueiras
- Department of Radiology, Hospital Comarcal de Monforte, Monforte de Lemos, Spain.
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24
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Rosés LL, Ramirez AG, Seco AL, Blanco ES, Alonso DI, Avila S, Lopez BU. Clip closure of a duodenal perforation secondary to a biliary stent. Gastrointest Endosc 2000; 51:487-9. [PMID: 10744829 DOI: 10.1016/s0016-5107(00)70454-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- L L Rosés
- Unidad de Endoscopia, Hospital Xeral, Lugo, Spain
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25
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Paraskeva KD, Bury RW, Isaacs P. Streptococcus milleri liver abscesses: an unusual complication after colonoscopic removal of an impacted fish bone. Gastrointest Endosc 2000; 51:357-8. [PMID: 10699792 DOI: 10.1016/s0016-5107(00)70372-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- K D Paraskeva
- Department of Gastroenterology, Victoria Hospital, Blackpool, Lancashire, United Kingdom
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26
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Abstract
In a series of 66 patients who had palliation of malignant obstructive jaundice by percutaneous placement of Memotherm expanding metal stents, we report four cases of stent fracture. This has not been reported previously.
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Affiliation(s)
- R Peck
- X-Ray Department, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
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27
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Mastorakos DP, Milman PJ, Cohen R, Goldenberg SP. An unusual complication of a biliary stent-small bowel perforation of an incarcerated hernia sac. Am J Gastroenterol 1998; 93:2533-5. [PMID: 9860420 DOI: 10.1111/j.1572-0241.1998.00712.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present a case of small bowel perforation after migration of an endoscopically inserted biliary stent inside an incarcerated hernia sac. A review of the literature revealed no other report of stent morbidity associated with hernias. The management and implications are discussed.
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