Successive breaks in biliary stents.

Area of Science:

• Gastroenterology
• Oncology
• Interventional Endoscopy

Background:

• Obstructive jaundice in a 64-year-old male was caused by a well-differentiated pancreatic neuroendocrine tumor with liver metastases.
• Endoscopic retrograde cholangiopancreatography (ERCP) was used for initial treatment.

Observation:

• A covered self-expanding biliary stent was placed via ERCP.
• The patient presented with cholangitis one year later due to stent fracture and migration.
• A subsequent ERCP revealed a fragmented stent in the common bile duct, necessitating its removal and replacement.

Findings:

• Four months after stent replacement, the patient again developed cholangitis.
• A repeat ERCP showed the newly inserted biliary stent had also fragmented.
• The fragmented stent was removed, and an uncovered stent was inserted.

Implications:

• This case highlights potential complications and challenges in managing obstructive jaundice with biliary stents in patients with pancreatic neuroendocrine tumors.
• Recurrent stent fragmentation suggests a need for further investigation into stent durability and patient-specific factors.
• Alternative or modified stent strategies may be required for long-term management.