Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography: A case report

Table 1 Published case reports of endoscopic retrograde cholangiopancreatography-related stent malpositioning in the portal vein

Ref.	Gender, age	Indication for ERCP	Procedure	Stent	Clinical manifestation	Treatment	Follow-up	Outcome
Stableforth et al[6], 2011	Male, 73	Pancreatic cancer	PBS replacement	7-Fr, 10-cm straight	Consistent jaundice; Brisk bleeding after removal of the stent; Filling of the portal vein and rapid washout of contrast material; confirmed by CT	PBS left in situ; metal stent placement via PTC	2 months	No complications
Miloudi et al[7], 2011	Female, 60	Benign narrowing of the CBD after transplantation	PBS replacement	10-Fr, 10-cm	Difficult insertion of the new PBS; Fever and abdominal pain shortly after ERCP; Confirmed by abdominal ultrasound and CT	Surgery to remove the prosthesis, close the fistula, repair the portal vein, and develop hepatico-jejunal anastomosis	Several days	Uneventful
Leung et al[8], 2012	Female, 10	Recurrent pancreatitis	Pancreatic sphincterotomy, pancreatic stent placement	3-Fr, 6 cm, pigtail	Fever, abdominal pain, and elevated amylase; Confirmed by ultrasound and CT	Remove the stent by ERCP on the 3rd postoperative day	3 months	Portal vein thrombosis gradually resolved
Dawwas et al[9], 2013	Male, 69	CBD stones	Difficult cannulation, biliary sphincterotomy, PBS placement	7-Fr, 4-cm, double pigtail	Bleeding after removal of previous stent, and faint, rapidly dissipating, biliary-like opacification on contrast injections	Abandon the procedure immediately	2 months	Gas and thrombosis in the portal vein gradually resolved
So et al[10], 2015	Male, 55	Hilar invasion of hepatocellular carcinoma	PBS replacement	NA	Recurrent melena and bacteremia; Exacerbated bleeding after removing the stent; Cholangiography revealed leakage of contrast dye into the portal vein	Placing fully covered self-expandable metal stent in the bile duct	Several days	Recovering from recurrent bacteremia and bleeding
Russo et al[11], 2017	Female, 39	Acute cholangitis	Biliary sphincterotomy, failed sweeping of stones by a ballon, and PBS placement	7-Fr, 7-cm	Resistance on stent placement, bleeding upon stent deployment	PBS left in situ, emergent laparotomy to repair the injury and T-tube placement	Several days	Resolve from the surgery
João et al[12], 2022	Female, 60	Biliary anastomotic stenosis after liver transplantation	Difficult cannulation, biliary sphincterotomy, balloon dilation, PBS placement	Two 8.5-Fr, 9.0-cm	Spurting hemorrhage when removing the stent	Endoscopic removal of stent, percutaneous transhepatic fully covered self-expanded metal stent in the portal vein	1 month	Clinically stable, no bleeding relapse
Lin et al[3], 2023	Male, 34	CBD stones, cholangitis	Difficult cannulation, sphincterotomy, balloon dilation, PBS placement	7-Fr	Hemobilia upon inserting the stent; Confirmed by CT scan	Surgery: Cholecystectomy and CBD stones removement, endoscopic removal of stent	9 months	Uneventful
Taşar et al[4], 2023	Female, 54	CBD stones, cholangitis	Difficult cannulation, sphincterotomy, stone extraction, PBS placement	10-Fr, 7-cm	Hemorrhage, fever and persistent jaundice; Confirmed by CT scan	Laparoscopic exploration with ERCP	Several months	Chronic portal thrombus

ERCP: Endoscopic retrograde cholangiopancreatography; PBS: Plastic biliary stent; CT: Computed tomography; CBD: Common bile duct; PTC: Percutaneous transhepatic cholangiography.