Erosion and perforation of the biliary tree by plastic biliary endoprostheses

Biliary endoprostheses are increasingly used in the treatment of both benign and malignant pancreaticobiliary disorders. Common bile duct stones are a common clinical problem for which there now exist a range of treatment modalities. Official guidelines in the UK advocate the use of plastic biliary endoprostheses in the treatment of common bile duct stones only as a short-term measure prior to definitive endoscopic or surgical clearance. Long-term use of such stents is associated with several complications related to stent insertion, occlusion, and migration. Organ perforation resulting from plastic biliary stents is very rare and can occur either as an early complication at stent insertion or as a late complication resulting from stent migration and pressure necrosis. Although duodenal, small-bowel, and colonic perforations have been described, we have found no reports of extra-hepatic bile duct perforation occurring as a complication of plastic biliary stents. We present three cases of biliary tree erosion and perforation by plastic stents placed in patients with common bile duct stones cleared endoscopically prior to laparoscopic cholecystectomy and discuss the possible implications of this previously unreported phenomenon.

References

• 1 Fatima J, Baron T H, Topazian M D. et al . Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures.  Arch Surg. 2007;  142 448-455
• 2 Kroh M, Chand B. Choledocholithiasis, endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration.  Surg Clin N Am. 2008;  88 1019-1031
• 3 Donelli G, Guaglianone E, Di Rosa R. et al . Plastic biliary stent occlusion: factors involved and possible preventive approaches.  Clin Med Res. 2007;  5 53-60
• 4 Dunshea T J, Little A F. Gastrointestinal haemorrhage due to erosion of the duodenal wall by a biliary stent.  Australas Radiol. 2005;  49 69-71
• 5 Margulies C, Siqueira E S, Silverman W B. et al . The effect of endoscopic sphincterotomy on acute and chronic complications of biliary endoprostheses.  Gastrointest Endosc. 1999;  49 716-719
• 6 Akimboye F, Lloyd T, Hobson S, Garcea G. Migration of endoscopic biliary stent and small bowel perforation within an incisional hernia.  Surg Laparosc Endosc Percutan Tech. 2006;  16 39-40
• 7 Bharathi R S, Rao P P, Ghosh K. Intra-peritoneal duodenal perforation caused by delayed migration of endobiliary stent: a case report.  Int J Surg. 2008;  6 478-480
• 8 Zuber-Jerger I, Endlicher E, Kullmann F, Gelbmann C M. A new grading system to evaluate the risk of endoscopic retrograde cholangiopancreatography.  J Gastroenterol. 2009;  44 160-165
• 9 Assimakopoulos S F, Thomopoulos K C, Giali S. et al . A rare etiology of post-endoscopic retrograde cholangiopancreatography pneumoperitoneum.  World J Gastroenterol. 2008;  14 2917-2919
• 10 Williams E J, Green J, Beckingham I. et al . Guidelines on the management of common bile duct stones (CBDS).  Gut. 2008;  57 1004-1021
• 11 Ang T L, Fock K M, Teo E K. et al . An audit of the outcome of long-term biliary stenting in the treatment of common bile duct stones in a general hospital.  J Gastroenterol. 2006;  41 765-771
• 12 Bajbouj M, Treiber M, Ludwig L. et al . Forgotten biliary endoprosthesis – “follow up” after 10 years.  Endoscopy. 2008;  40 E221
• 13 Chaurasia O P, Rauws E AJ, Fockens P, Huibregtse K. Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience.  Gastrointest Endosc. 1999;  50 780-785
• 14 Boerma D, Rauws E AJ, Keulemans Y CA. et al . Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial.  Lancet. 2002;  360 761-765
• 15 Salman B, Yilmaz U, Kerem M. et al . The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cholelithiasis coexisting with choledocholithiasis.  J Hepatobiliary Pancreat Surg. 2009;  16 832-836
• 16 UK Working Party on Acute Pancreatitis . UK guidelines for the management of acute pancreatitis.  Gut. 2005;  54 (Suppl III) iii1-iii9
• 17 Khan M N, Nordon I, Ghauri A SK. et al . Urgent cholecystectomy for acute cholecystitis in a district general hospital – is it feasible?.  Ann R Coll Surg Engl. 2009;  91 30-34
• 18 Mesenas S, Vu C, Doig L, Meenan J. Duodenal EUS to identify thickening of the extrahepatic biliary tree wall in primary sclerosing cholangitis.  Gastrointest Endosc. 2006;  63 403-408
• 19 Scheeres D, O’Brien W, Ponsky L, Ponsky J. Endoscopic stent configuration and bile flow rates in a variable diameter bile duct model.  Surg Endosc. 1990;  4 91-93
• 20 Seitz U, Goenka M K, Bohnacker S. et al . Endoscopic biliary stenting: plastic stent or expandable metallic stent?.  J Hepatobiliary Pancreat Surg. 1997;  4 24-30