Bowel Perforation Caused by Biliary Stent Migration After ERCP

Author:

Wilson Natalie1,Ezeani Chukwunonso2,Ismail Abdellatif3,Abdalla Monzer4,Mohammed Shaikhoon5,Abdalla Abubaker6,Elawad Ayman7,Beran Azizullah8,Jaber Fouad9,Abosheaishaa Hazem10,Loon Erica1,Abdallah Mohamed11,Vargo John11,Bilal Mohammad12,Chahal Prabhleen11

Affiliation:

1. Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN

2. Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA

3. Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD

4. Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL

5. Department of Medicine, Atrium Navicent Health, Milledgeville, GA

6. Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA

7. Department of Internal Medicine, Howard University Hospital, Washington, DC

8. Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN

9. Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO

10. Department of Internal Medicine, Mount Sinai, New York, NY

11. Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH

12. Division of Gastroenterology and Hepatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference93 articles.

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3. Migratory biliary stent resulting in colonic perforation: a rare complication and review of literature;Wilson;J Surg Case Rep,2023

4. Small bowel perforation from a migrated biliary stent: A case report and review of literature;Zorbas;World J Gastrointest Endosc,2021

5. Biliary stent migration with duodenal perforation;Yaprak;The Eurasian J Med,2008

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