Re: Bowel perforation: a ‘not so rare’ complication of biliary stent migration

Abstract

Re: Bowel perforation: a 'not so rare' complication of biliary stent migration Dear Editor, We read with great interest an article entitled: Bowel perforation: a 'not so rare' complication of biliary stent migration by Brown et al. recently published in your esteemed journal. 1 It is indeed a rare case series. We would like to congratulate the authors for reporting such unusual cases. We have a few comments regarding the article that you may find pertinent.In the series presented by the authors, we noted that all the stents were straight plastic biliary stents. In addition, in table 1, only case number 1 had pigtail and straight both stents, but on checking the original report, we found that migrated stent was straight biliary stent. 2 From the available literature, Yagnik et al. (2018) observed that most reported cases of luminal perforation with biliary stents had been associated with a straight biliary stent. Therefore, they suggest that double pigtail stents are used to prevent such perforation and migration as pigtail stents are less likely to migrate distally. 3 They are placed slightly differently than straight stents. 3 Authors had also mentioned that early cholecystectomy followed by removal of plastic stents within 3 months of insertion should be instituted as per European Society of Gastrointestinal Endoscopy (ESGE) recommendations. 4 However, this recommendation may not be worth preventing migration and perforation as, in the present series, all the cases perforation was developed before 3 months. We suggest the following advice given by Yagnik et al. to use a double pigtail stent instead of a straight stent to prevent such disastrous complication. 3