CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1530-E1536
DOI: 10.1055/a-1231-4758
Original article

A rare complication of ERCP: duodenal perforation due to biliary stent migration

Mark A. Gromski
1  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
,
Benjamin L. Bick
1  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
,
David Vega
2  Indiana University School of Medicine, Indianapolis, IN, USA
,
Jeffrey J. Easler
1  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
,
James L. Watkins
1  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
,
Stuart Sherman
1  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
,
Glen A. Lehman
1  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
,
Evan L. Fogel
1  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
› Author Affiliations
  

Abstract

Background and study aims Perforation of the duodenal wall opposing the major papilla due to a migrated pancreatobiliary stent rarely has been described in the literature as a complication of endoscopic retrograde cholangiopancreatography (ERCP). Factors associated with perforation from migrated stents from ERCP are unknown.

Patients and methods This was a retrospective, observational study. Patients were identified from January 1, 1994 to May 31, 2019 in a prospectively maintained ERCP database.

Results Eleven cases of duodenal perforation from migrated pancreatobiliary stents placed at ERCP were identified during the study period. All cases involved biliary stents, placed for biliary stricture management. The perforating stent was plastic in 10 cases (91 %). This complication occurred in one in 2,293 ERCP procedures in which a pancreatobiliary stent was placed.

Conclusion This complication is more common with biliary stents compared to pancreatic stents. This may be related to the angle of exit of biliary stents being more perpendicular to the opposing duodenal wall and the near exclusive use of external pigtail plastic stents in the pancreatic duct. All perforating plastic stents were ≥ 9 cm in length. Longer stents may provide leverage for perforation with a migration event.



Publication History

Received: 18 December 2019

Accepted: 11 May 2020

Publication Date:
21 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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