Biliary complications secondary to post-cholecystectomy clip migration: a review of 69 cases
Vui Heng Chong1, Chee Fui Chong
1Endoscopy Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710 Brunei Darussalam. chongvuih@yahoo.co.uk
Introduction:
Post-cholecystectomy clip migration (PCCM) is rare and can lead to complications which include clip-related biliary stones. Most have been reported as case reports. This study reviews cases of clip migration reported in the literatures.
Method:
Searches and reviews of the literatures from "PubMed," "EMBASE," and "Google Scholar" search engines using the keywords "clip migration" and "bile duct stones" were carried out. Eighty cases from 69 publications were identified but details for only 69 cases were available for the study.
Results:
The median age at presentations of PCCM was 60 years old (range, 31 to 88 years; female, 61.8%) and the median time from the initial cholecystectomy to clinical presentations was 26 months (range, 11 days to 20 years). Of primary surgeries, 23.2% was for complicated gallstones disease. The median number of clips placed during surgery was six (range, two to more than ten clips). Common diagnoses at presentations of PCCM were obstructive jaundice (37.7%), cholangitis (27.5%), biliary colic (18.8%), and acute pancreatitis (8.7%). The median number of migrated clip was one (range, one to six). Biliary dilatation and strictures were encountered in 74.1% and 28.6%, respectively. Of the 69 cases of PCCM-associated complications, 53 (77%) were successfully treated with endoscopic retrograde cholangiopancreatography (ERCP), 14 (20.2%) with surgery, and one (1.4%) with successful percutaneous transhepatic cholangiography treatment. One patient had spontaneous clearance of PCCM. There was no reported mortality related to PCCM.
Conclusion:
PCCM can occur at any time but typically occur at a median of 2 years after cholecystectomy. Clinical presentations are similar to those with primary or secondary choledocholithiasis. Most can be managed successfully with ERCP.
Insights
Post-cholecystectomy clip migration (PCCM) is a rare complication that can occur years after surgery. Most cases present with jaundice or cholangitis and are successfully treated with endoscopic retrograde cholangiopancreatography (ERCP).
Area of Science:
- Gastroenterology
- Surgical Complications
- Biliary System Disorders
Background:
- Post-cholecystectomy clip migration (PCCM) is a rare complication.
- It can lead to significant issues such as clip-related biliary stones.
- Most reported cases are individual case reports, highlighting a need for broader analysis.
Purpose of the Study:
- To review and analyze reported cases of clip migration after cholecystectomy.
- To understand the clinical presentation, complications, and management of PCCM.
- To consolidate existing literature on this rare condition.
Main Methods:
- Literature search of PubMed, EMBASE, and Google Scholar.
- Keywords used: "clip migration" and "bile duct stones".
- Analysis of 69 cases with available details from 80 identified publications.
Main Results:
- Median age at presentation was 60 years, with a median of 26 months post-cholecystectomy.
- Common presentations included obstructive jaundice (37.7%) and cholangitis (27.5%).
- Endoscopic retrograde cholangiopancreatography (ERCP) achieved a 77% success rate in managing PCCM complications.
Conclusions:
- PCCM can manifest years after cholecystectomy, with presentations mimicking choledocholithiasis.
- ERCP is a highly effective treatment modality for PCCM-associated complications.
- While rare, PCCM requires awareness for timely diagnosis and management.
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