Cholecystocolonic fistula resulting from biliary stent migration

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Innovation

Background:

• Biliary stent placement is common for cholecystitis.
• Rarely, stent dislocation can lead to colonic perforation and fistula formation.
• This case details a biliary stent migrating between the transverse colon and gallbladder, forming a cholecystocolonic fistula.

Purpose of the Study:

• To highlight the importance of early recognition of biliary stent migration complications.
• To describe a novel, minimally invasive approach for cholecystocolonic fistula closure.

Main Methods:

• A novel technique involving simultaneous bidirectional endoscopy was employed.
• Colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP) were performed concurrently.
• This allowed direct visualization and closure of the fistulous tract during stent removal.

Main Results:

• The combined endoscopic approach enabled precise grasping and closure of the fistula.
• The eroding biliary stent was replaced in the same session.
• Procedure time and anesthesia exposure were minimized for the patient.

Conclusions:

• Simultaneous bidirectional endoscopy is an effective management strategy for biliary-enteric fistulas.
• This technique facilitates direct visualization and closure while addressing the causative stent in one procedure.
• It offers a potential alternative to surgery, reducing adverse events for select patients.