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Bowel Perforation Caused by Biliary Stent Migration After ERCP: A Systematic Review.
Natalie Wilson1, Chukwunonso Ezeani2, Abdellatif Ismail3
1Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN.
Journal of Clinical Gastroenterology
|July 15, 2024
Summary
Bowel perforation from migrated endoscopic retrograde cholangiopancreatography (ERCP) stents is a rare but serious complication. Most cases involve plastic biliary stents within 44.5 days, with a significant mortality rate of 17.4%.
Area of Science:
- Gastroenterology
- Endoscopy
- Surgical Complications
Background:
- Distal migration of biliary stents after ERCP can lead to serious complications.
- While most migrated stents pass without issue, bowel perforation is a reported adverse event.
Purpose of the Study:
- To systematically review risk factors, clinical features, and outcomes of bowel perforation due to stent migration post-ERCP.
- To identify characteristics of patients and stents associated with this complication.
Main Methods:
- Comprehensive literature search of PubMed, EMBASE, and Cochrane databases up to October 2023.
- Inclusion of full-length English articles reporting bowel perforation from stent migration, excluding incomplete or proximal migration.
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
Main Results:
- 132 cases of bowel perforation were identified from 92 articles.
- Perforation most commonly occurred in the small bowel (64.4%) within a median of 44.5 days, often involving 10 Fr plastic stents.
- Management included surgery (52.3%) or endoscopy (42.4%), with 25.8% requiring bowel resection and an overall mortality of 17.4%.
Conclusions:
- Bowel perforation after ERCP stent migration is a significant risk, particularly with plastic biliary stents within 44.5 days.
- The overall mortality rate highlights the severity of this complication.
- Endoscopists must remain vigilant for this rare but potentially fatal adverse event.
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