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

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.

Fig. 1

Duodenal perforation due to biliary stent migration. a Biliary stent noted to perforate the duodenal wall. b Stent removal with grasping forceps. c Identification of perforation (yellow arrow). d Closure of perforation with three endoclips.

Fig. 2

Duodenal perforation due to biliary stent migration. a Biliary stent noted to perforate the duodenal wall. b Stent removal with grasping forceps. c Identification of perforation (yellow arrow). d Closure of perforation with two endoclips.

Fig. 3

Duodenal perforation from biliary stent (blue arrow) noted intraoperatively.