Lateral duodenal wall perforation due to plastic biliary stent migration: a case series of endoscopic closure

Abstract

Background and study aims Lateral duodenal wall perforation by a migrated stent is a potential complication of biliary stenting. By systematic database revision, we identified a series of six patients with lateral duodenal wall perforation caused by a displaced plastic biliary stent that were treated with over-the-scope clip (OTSC) between January 1, 2014 and March 31, 2019. In this series, most cases were related to stenting of benign strictures with single or double stenting and with the use of stents longer than 12 cm. OTSC permitted perforation closure in all cases. Most patients had an excellent outcome and did not need any subsequent intervention. However, one patient, who presented with a more severe pneumoretroperitoneum on computed tomography scan, required laparotomy with peritoneal lavage and eventually died due to this complication. We conclude that endoscopic treatment of these perforations with OTSC could be an effective alternative to surgery in selected patients.

Publication History

Received: 14 August 2019

Accepted: 28 October 2019

Article published online:
17 April 2020

• References

• 1 Bray MS, Borgert AJ, Folkers ME. et al. Outcome and management of endoscopic retrograde cholangiopancreatography perforations: A community perspective. Am J Surg 2017; 214: 69-73
• 2 Ferm S, Fisher C, Hassam A. et al. Primary Endoscopic closure of duodenal perforation secondary to biliary stent migration: a case report and review of the literature. J Investig Med High Impact Case Rep 2018; DOI: 10.1177/2324709618792031.
• 3 Kim SH, Moon JH, Lee YN. et al. Endoscopic management of duodenal perforation caused by migrated biliary stents. Endosc Int Open 2019; 07: E792-E795
• 4 Paspatis GA, Dumonceau JM, Barthet M. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2014; 46: 693-711
• 5 Javia SB, Patel R, Singhal S. Endoscopic closure with an over-the-scope clip of a duodenocolonic fistula caused by a migrated biliary stent. Gastrointest Endosc 2016; 83: 845-846; discussion 846-847
• 6 Kriss M, Yen R, Fukami N. et al. Duodenal perforation secondary to migrated biliary stent in a liver transplant patient: successful endoscopic closure with an over-the-scope clip. Gastrointest Endosc 2015; 81: 1258-1259
• 7 Le Mouel JP, Hakim S, Thiebault H. Duodenal perforation caused by early migration of a biliary plastic stent: closure with over-the-scope clip. Clin Gastroenterol Hepatol 2019; 17: e6-e7
• 8 Arhan M, Odemis B, Parlak E. et al. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc 2009; 23: 769-775
• 9 Cheruvu S, Kennedy R, Moshenyat Y. et al. Biliary stent migration: a brief review of potential complications and possible etiological factors. Am J Ther 2014; 21: e124-129
• 10 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017. Endoscopy 2018; 50: 910-930