Endoscopic management of duodenal perforations caused by migrated biliary plastic stents

Abstract

Background and study aims Duodenal perforation by migration of plastic stents placed to treat biliary lesions is rare but can be life-threatening. Surgical management is preferred, but it may increase risks of mortality and morbidity, especially in patients with underlying comorbidities and those of advanced age. We describe five cases of duodenal perforation that were successfully managed endoscopically. Four patients were elderly, and one had end-stage renal disease. We used cylindrically adapted cap-fitted endoscopy to successfully retrieve migrated plastic stents and to close the perforated walls with hemoclips. No post-procedural complication was noted. In conclusion, endoscopic management is appropriate as a first-line approach in patients with duodenal perforations caused by plastic stent migration.

• References

• 1 Sinha S, Wardle A, Kalidindi V. et al. Erosion and perforation of the biliary tree by plastic biliary endoprostheses. Endoscopy 2010; 42: 760-763
• 2 Saranga Bharathi R, Rao P. et al. Iatrogenic duodenal perforations caused byendoscopic biliary stenting and stent migration: an update. Endoscopy 2006; 38: 1271-1274
• 3 Dumonceau JM, Tringali A, Blero D. et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44: 277-298
• 4 Perdue DG, Freeman ML, DiSario JA. et al. Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study. J Clin Gastroenterol 2008; 42: 1040-1046
• 5 Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38: 341-346
• 6 Cheon YK, Oh HC, Cho YD. et al. New 10F soft and pliable polyurethane stents decrease the migration rate compared with conventional 10F polyethylene stents in hilar biliary obstruction: results of a pilot study. Gastrointest Endosc 2012; 75: 790-797
• 7 Mutignani M, Iacopini F, Dokas S. et al. Successful endoscopic closure of a lateral duodenal perforation at ERCP with fibrin glue. Gastrointest Endosc 2006; 63: 725-727
• 8 Roses LL, Ramirez AG, Seco AL. et al. Clip closure of a duodenal perforation secondary to a biliary stent. Gastrointest Endosc 2000; 51: 487-489
• 9 Lee TH, Bang BW, Jeong JI. et al. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation. World J Gastroenterol 2010; 16: 2305-2310
• 10 Prachayakul V, Aswakul P, Kachintorn U. Duodenal perforation due to plastic stent migration successfully treated by endoscopy. Gastrointest Endosc 2012; 75: 1265-1266