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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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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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Lee TH, Han JH, Park SH. Endoscopic treatments of endoscopic retrograde cholangiopancreatography-related duodenal perforations. Clin Endosc 2013; 46:522-8. [PMID: 24143315 PMCID: PMC3797938 DOI: 10.5946/ce.2013.46.5.522] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/25/2013] [Indexed: 12/13/2022] Open
Abstract
Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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O'Connor R, Agrawal S, Aoun E, Kulkarni A. Biliary stent migration presenting with leg pain. BMJ Case Rep 2012; 2012:bcr-2012-007588. [PMID: 23162034 DOI: 10.1136/bcr-2012-007588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although the therapeutic benefits of endoscopic retrograde cholangiopancreatography (ERCP) usually outweigh the risks, there can be rare complications, including stent migration leading to perforation, intestinal obstruction or penetration. An 87-year-old woman presented with symptomatic choledocholithiasis. Two previous endoscopic attempts at stone removal were unsuccessful. On repeat ERCP at our institution, multiple large stones were removed, but complete duct clearance could not be achieved. A plastic biliary stent was placed with plans to reattempt in 6 weeks. Postoperatively, she had mild back pain radiating into her right leg that gradually worsened to the point where she was unable to ambulate. An abdominal CT scan showed the distal aspect of the biliary stent extending through the wall of the duodenum with the tip positioned within the right psoas muscle. The stent was successfully removed via a rat-toothed forceps. Our case illustrates an extremely rare complication of biliary stent placement.
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Affiliation(s)
- Ryan O'Connor
- West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA
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Escudero E, Eduardo Dolan M, Grassano L, Ferrer E, Gil Pomar J. [Intestinal perforation due to migration of a biliary prosthesis: Mini-invasive treatment]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:684-5. [PMID: 20630623 DOI: 10.1016/j.gastrohep.2010.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
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Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers. Surg Laparosc Endosc Percutan Tech 2009; 19:217-21. [PMID: 19542849 DOI: 10.1097/sle.0b013e3181a031f5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Proximal or distal migration of a plastic biliary stent is uncommon, but its management can be a technical challenge to the pancreatobiliary endoscopist. PATIENTS AND METHODS All cases (n=51) of proximally and distally migrated plastic biliary stents over an 8-year period at 3 referral pancreaticobiliary centers were included in this retrospective study. Indications for stenting, risk factors for migration, presentation of migration, and various techniques used for stent's retrieval are herein analyzed. RESULTS Twenty-one proximal and 30 distal bile duct-migrated stents were identified. All patients with proximally and 17 (56.7%) with distally migrated stents were symptomatic. Choledocholithiasis, dilated common bile duct, short and large size stent were the main risk factors. The retrieval of proximally migrated stents was successful in 15 patients (71.4%) and in all symptomatic patients with distal migration. The retrieval techniques included forceps, Dormia basket, snare, Soehendra stent retriever, and balloon. One patient died of sepsis due to peritonitis from duodenal perforation from a distally migrated stent. CONCLUSIONS Retrieval of a proximally migrated stent requires experience with different endoscopic devices. Moreover, distal migration needs attention because it can cause severe complications.
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Akbulut S, Cakabay B, Ozmen CA, Sezgin A, Sevinc MM. An unusual cause of ileal perforation: Report of a case and literature review. World J Gastroenterol 2009; 15:2672-4. [PMID: 19496201 PMCID: PMC2691502 DOI: 10.3748/wjg.15.2672] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An ileal perforation resulting from a migrated biliary stent is a rare complication of endoscopic stent placement for benign or malignant biliary tract disease. We describe the case of a 59-year-old woman with a history of abdominal surgery in which a migrated biliary stent resulted in an ileal perforation. Patients with comorbid abdominal pathologies, including colonic diverticuli, parastomal hernia, or abdominal hernia, may be at increased risk of perforation from migrated stents.
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Brinkley M, Wible BC, Hong K, Georgiades C. Colonic Perforation by a Percutaneously Displaced Biliary Stent: Report of a Case and a Review of Current Practice. J Vasc Interv Radiol 2009; 20:680-3. [DOI: 10.1016/j.jvir.2009.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 01/23/2009] [Accepted: 02/02/2009] [Indexed: 12/18/2022] Open
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Culnan DM, Cicuto BJ, Singh H, Cherry RA. Percutaneous retrieval of a biliary stent after migration and ileal perforation. World J Emerg Surg 2009; 4:6. [PMID: 19183489 PMCID: PMC2642780 DOI: 10.1186/1749-7922-4-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/31/2009] [Indexed: 02/07/2023] Open
Abstract
We present a case of a migrated biliary stent that resulted in a distal small bowel perforation, abscess formation and high grade partial small bowel obstruction in a medically stable patient without signs of sepsis or diffuse peritonitis. We performed a percutaneous drainage of the abscess followed by percutaneous retrieval of the stent. The entero-peritoneal fistula closed spontaneously with a drain in place. We conclude, migrated biliary stents associated with perforation distal to the Ligament of Trietz (LOT), may be treated by percutaneous drainage of the abscess and retrieval of the stent from the peritoneal cavity, even when associated with a large intra-abdominal abscess.
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Affiliation(s)
- Derek M Culnan
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Bryan J Cicuto
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Harjit Singh
- Department of Radiology, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Robert A Cherry
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
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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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Losanoff JE, Vanha TG, Testa G, Ahmed EB, Millis JM. Endoscopic biliary stent migration to the iliopsoas muscle in a liver transplant recipient: percutaneous removal. Dig Dis Sci 2007; 52:2508-11. [PMID: 17436093 DOI: 10.1007/s10620-006-9725-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 12/03/2006] [Indexed: 01/14/2023]
Affiliation(s)
- Julian E Losanoff
- Department of Surgery, Section of Transplantation, MC 5026, Room J 517, University of Chicago, 5841 South Maryland Avenue Chicago, Illinois 60637, USA.
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13
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Affiliation(s)
- Michael Elliott
- Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia.
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14
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Mahadeva S, Ranjeev P, Goh KL. Hepaticogastric fistulation from a proximally migrated biliary stent. Gastrointest Endosc 2003; 58:295-7. [PMID: 12872109 DOI: 10.1067/mge.2003.355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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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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Wilhelm A, Langer C, Zoeller G, Nustede R, Becker H. Complex colovesicular fistula: A severe complication caused by biliary stent migration. Gastrointest Endosc 2003; 57:124-6. [PMID: 12518151 DOI: 10.1067/mge.2003.71] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Arne Wilhelm
- Department of General Surgery and Department of Urology, Georg-August-University, Goettingen, Germany
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17
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Maguire D, Rela M, Heaton ND. Biliary complications after orthotopic liver transplantation. Transplant Rev (Orlando) 2002. [DOI: 10.1053/trte.2002.1296481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Grassi R, Lassandro F, Romano L, Romano S. Enterolith around a migrated biliary stent. AJR Am J Roentgenol 2002; 178:1293. [PMID: 11959756 DOI: 10.2214/ajr.178.5.1781293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Roberto Grassi
- Second University of Naples 80138 Naples, Italy A. Cardarelli Hospital 80131 Naples, Italy
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Liebich-Bartholain L, Kleinau U, Elsbernd H, Büchsel R. Biliary pneumonitis after proximal stent migration. Gastrointest Endosc 2001; 54:382-4. [PMID: 11522987 DOI: 10.1067/mge.2001.113646] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Affiliation(s)
- S T Amann
- Pancreatic Interventional Services and Therapeutic Endoscopy, North Mississippi Medical Center, Tupelo, Mississippi, USA
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Broome CJ, Peck RJ. Hepatic abscess complicating foreign body perforation of the gastric antrum: an ultrasound diagnosis. Clin Radiol 2000; 55:242-3. [PMID: 10708622 DOI: 10.1053/crad.1999.0339] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- C J Broome
- Department of Diagnostic Imaging, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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Venbrux AC, Lambert DL, Lillemoe KD, Sofronski MD, Dellon SC. Small-bowel obstruction caused by passage of a self-expanding hexagonal cell nitinol stent in the clinical setting of an inguinal hernia. J Vasc Interv Radiol 1999; 10:359-62. [PMID: 10102203 DOI: 10.1016/s1051-0443(99)70043-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- A C Venbrux
- Johns Hopkins Hospital, Baltimore, MD 21287, USA
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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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