Risk factors for distal migration of biliary plastic stents and related duodenal injury

Abstract

Background The risk factors of duodenal injury from distal migrated biliary plastic stents remain uncertain. The aim of this study was to determine the risk factors of distal migration and its related duodenal injury in patients who underwent placement of a single biliary plastic stent for biliary strictures. Methods We retrospectively reviewed all patients with biliary strictures who underwent endoscopic placement of a single biliary plastic stent from January 2006 to October 2017. Results Two hundred forty-eight patients with 402 endoscopic retrograde cholangiopancreatography procedures were included. The incidence of distal migration was 6.2%. The frequency of duodenal injury was 2.2% in all cases and 36% in cases with distal migration. Benign biliary strictures (BBS), length of the stent above the proximal end of the stricture (> 2 cm), and duration of stent retention (< 3 months) were independently associated with distal migration (p = 0.018, p = 0.009, and p = 0.016, respectively). Duodenal injury occurred more commonly in cases with larger angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body (p = 0.018) or in cases with stent retention < 3 months (p = 0.031). Conclusions The risk factors of distal migration are BBS and the length of the stent above the proximal end of the stricture. The risk factor of duodenal injury due to distal migration is large angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body. Distal migration and related duodenal injury are more likely to present during the early period after biliary stenting.

A rare clinical presentation of third part duodenal perforation due to post‐endoscopic retrograde cholangiopancreatography stent migration on advanced stage peri‐ampullary tumor

“…A multivariate analysis study reported by Xiang‐lei et al in 2020 described the risk factors such as benign biliary stricture (BBS), a proximal stricture, the length of stent more than 10 cm, length of the proximal stent above the proximal end of the stricture (>2 cm), and duration of stent retention for more than 3 months. The results of logistic regression analysis of this study reported only BBS, length of the stent, and duration of stent retention was statistically relevant 9,10 . According to this risk factor study, the length of the stent in this case was more than 10 cm, which was associated with stent migration and leading to duodenal perforation.…”

“…Nonoperative management (NOM) was not the preferred option if the patient present with clinical sign and symptoms of peritonitis and already in septic condition. In stable, localized retroperitoneal perforation with minimal intra‐abdominal contamination, this NOM could achieve better clinical outcome 8–10 …”

“…Duodenum is the most common site of stent migration, which leads to perforation, and this migration could happen in up to 6% of stent placement during ERCP for biliary drainage procedures; although the stent migration that could lead to perforation can be found in less than 1% of cases, this is extremely rare complication related to ERCP 9 . As described before, an early diagnosed case and in stable patients, it could be managed by through‐the‐scope clip and stent evacuation at the same time of procedure 8 …”

“…In stable, localized retroperitoneal perforation with minimal intra‐abdominal contamination, this NOM could achieve better clinical outcome. 8 , 9 , 10 …”

Small Bowel Perforation Secondary to Biliary Stent Migration in an Incarcerated Inguinal Hernia

“…Proximal and distal stent migration are known complications of biliary stenting. It occurs in up to 6% of cases and commonly involves migration into the duodenum, with plastic stents migrating more often than metallic stents [1,2]. Approximately 50% of patients may be asymptomatic of stent migration.…”