Brief Article
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World J Gastroenterol. Feb 7, 2014; 20(5): 1318-1324
Published online Feb 7, 2014. doi: 10.3748/wjg.v20.i5.1318
Risk factors for proximal migration of biliary tube stents
Yoshiaki Kawaguchi, Masami Ogawa, Yohei Kawashima, Hajime Mizukami, Atsuko Maruno, Hiroyuki Ito, Tetsuya Mine
Yoshiaki Kawaguchi, Masami Ogawa, Yohei Kawashima, Hajime Mizukami, Atsuko Maruno, Hiroyuki Ito, Tetsuya Mine, Department of Gastroenterology, Tokai University School of Medicine, Isehara 259-1193, Japan
Author contributions: Kawaguchi Y contributed mainly to this work; Kawaguchi Y designed the research; Kawaguchi Y, Ogawa M, Kawashima Y, Mizukami H, Maruno A and Ito H performed the research; Kawaguchi Y and Mine T analyzed the data; Kawaguchi Y wrote the paper.
Correspondence to: Yoshiaki Kawaguchi, MD, PhD, Department of Gastroenterology, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan. y711kawa@is.icc.u-tokai.ac.jp
Telephone: +81-463-931121 Fax: +81-463-937134
Received: August 13, 2013
Revised: September 24, 2013
Accepted: September 29, 2013
Published online: February 7, 2014
Processing time: 191 Days and 9.5 Hours
Abstract

AIM: To analyze the risk factors for biliary stent migration in patients with benign and malignant strictures.

METHODS: Endoscopic stent placement was performed in 396 patients with bile duct stenosis, at our institution, between June 2003 and March 2009. The indications for bile duct stent implantation included common bile duct stone in 190 patients, malignant lesions in 112, chronic pancreatitis in 62, autoimmune pancreatitis in 14, trauma in eight, surgical complications in six, and primary sclerosing cholangitis (PSC) in four. We retrospectively examined the frequency of stent migration, and analyzed the patient factors (disease, whether endoscopic sphincterotomy was performed, location of bile duct stenosis and diameter of the bile duct) and stent characteristics (duration of stent placement, stent type, diameter and length). Moreover, we investigated retrieval methods for migrated stents and their associated success rates.

RESULTS: The frequency of tube stent migration in the total patient population was 3.5%. The cases in which tube stent migration occurred included those with common bile duct stones (3/190; 1.6%), malignant lesions (2/112; 1.8%), chronic pancreatitis (4/62; 6.5%), autoimmune pancreatitis (2/14; 14.3%), trauma (1/8; 12.5%), surgical complications (2/6; 33.3%), and PSC (0/4; 0%). The potential risk factors for migration included bile duct stenosis secondary to benign disease such as chronic pancreatitis and autoimmune pancreatitis (P = 0.030); stenosis of the lower bile duct (P = 0.031); bile duct diameter > 10 mm (P = 0.023); duration of stent placement > 1 mo (P = 0.007); use of straight-type stents (P < 0.001); and 10-Fr sized stents (P < 0.001). Retrieval of the migrated stents was successful in all cases. The grasping technique, using a basket or snare, was effective for pig-tailed or thin and straight stents, whereas the guidewire cannulation technique was effective for thick and straight stents.

CONCLUSION: Migration of tube stents within the bile duct is rare but possible, and it is important to determine the risk factors involved in stent migration.

Keywords: Migration; Endoscopic biliary stent; Risk factor; Endoscopic retrograde cholangiopancreatography; Retrieval

Core tip: Endoscopic biliary stenting with a tube stent is an accepted therapy for biliary obstruction due to malignant or benign disease. However, stent migration occurs in 5%-10% of patients undergoing biliary stenting. Therefore, it is important to know the factors affecting biliary tube stent migration. We retrospectively examined endoscopic stent placement in 396 patients with bile duct stenosis, and analyzed the frequency of stent migration and the risk factors (patient factors disease, endoscopic sphincterotomy, location of stenosis, diameter of bile duct) and stent factors (duration of placement, type, diameter, length).