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Migration of biliary plastic stents: experience of a tertiary center

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Abstract

Background and study aims

Stent migration occurs in about 5–10% of patients undergoing biliary stenting. The aim of this study was to analyze the risk factors for stent migration in patients with benign and malignant strictures.

Patients and methods

We retrospectively analyzed records of 524 biliary plastic stent placement procedures. Details noted included the cause and localization of stricture, characteristics and number of stents, direction of stent migration, presentation of patient with migrated stent, and the methods used for retrieval of migrated stents.

Results

Two hundred and four (38.9%) of the procedures were performed for benign biliary strictures (BBS) and 320 (61.1%) for malignant biliary strictures (MBS). Thirty-four patients had 45 migrated biliary stents. The rate of migration was 8.58% (proximal 4.58% and distal 4.00%). Migration frequency was higher in BBS compared with MBS (13.7% versus 5.3%, p = 0.001). In BBS, the rate of stent migration was higher in cases with one (19.3%) and two stents (20.9%) when compared with cases with multiple stents (2.7%) (p = 0.001; p = 0.001, respectively). Migration occurred more frequently (10.9%) in cases with two stents when compared both to cases with one stent (3.0%) and those with multiple stents (0%) in MBS (p = 0.008; p = 0.020, respectively). In BBS, short stents migrated more frequently proximally (77%) and long stents more frequently distally (73%) (p = 0.008). In BBS, migration in cases with proximal stricture occurred more frequently distally (76.9%), while in those with distal stricture, migration was more frequently proximal (73.3%) (p = 0.008). All of the proximally migrated stents could be successfully retrieved endoscopically.

Conclusions

The risk of stent migration is higher in BBS compared with in MBS. The cases with multiple stents had significantly lower stent migration. In BBS, long stent, proximal and postcholecystectomy strictures were associated with distal migration, while short stent, distal and non-postcholecystectomy strictures were associated with proximal migration.

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References

  1. Seitz U, Valdeyar H, Soehendra N (1994) Prolonged patency with a new-design teflon biliary prosthesis. Endoscopy 26:478–482

    Article  PubMed  CAS  Google Scholar 

  2. Sung JJY, Chung SCS (1995) Endoscopic stenting for palliation of malignant obstruction: a review of progress in the last 15 years. Dig Dis Sci 40:1177

    Article  Google Scholar 

  3. Speer AG, Cotton PB, Russell RCG, Mason RR, Hatfield AR, Leung JW et al (1987) Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet 2:57–62

    Article  PubMed  CAS  Google Scholar 

  4. Huibregtse K, Katon RM, Coene PP, Tytgat GNJ (1986) Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc 32:334–338

    Article  PubMed  CAS  Google Scholar 

  5. Shepherd HA, Royle G, Ross APR, Diba A, Arthur M, Colin-Jones D (1988) Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 75:1166–1168

    Article  PubMed  CAS  Google Scholar 

  6. Huibregtse K (1988) Endoscopic biliary and pancreatic drainage. Thieme Medical, New York, pp 93–120

    Google Scholar 

  7. Geenen DJ, Geenen JE, Hogan WJ, Schenck J, Venu RP, Johnson GK et al (1989) Endoscopic therapy for benign bile duct strictures. Gastrointest Endosc 35:367–371

    Article  PubMed  CAS  Google Scholar 

  8. Davids PH, Rauws EA, Coene PP, Tytgat GN, Huibregtse K (1992) Endoscopic stenting for post-operative biliary strictures. Gastrointest Endosc 38:12–18

    Article  PubMed  CAS  Google Scholar 

  9. Davids PH, Rauws EA, Tytgat GN, Huibregtse K (1992) Postoperative bile leakage: endoscopic management. Gut 33:1118–1122

    Article  PubMed  CAS  Google Scholar 

  10. Bergman JJ, van den Brink GR, Rauws EA, de Wit L, Obertop H, Huibregtse K et al (1996) Treatment of bile duct lesions after laparoscopic cholecystectomy. Gut 38:141–147

    Article  PubMed  CAS  Google Scholar 

  11. Deviere J, Baize M, de Toeuf J, Cremer M (1988) Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 34:95–101

    Article  PubMed  CAS  Google Scholar 

  12. Deviere J, Devaere S, Baize M, Cremer M (1990) Endoscopic biliary drainage in chronic pancreatitis. Gastrointest Endosc 36:96–100

    Article  PubMed  CAS  Google Scholar 

  13. Siegel JH, Snady H (1986) The significance of endoscopically placed prostheses in the management of biliary obstruction due to carcinoma of the pancreas: results of nonoperative decompression in 277 patients. Am J Gastroenterol 81:634–641

    PubMed  CAS  Google Scholar 

  14. Neuhaus H (1989) Endoscopic tumor therapy. Endoscopy 21(Suppl 1):357–360

    Article  PubMed  Google Scholar 

  15. Blake AM, Monga N, Dunn EM (2004) Biliary stent causing colovaginal fistula: case report. JSLS 8:73–75

    PubMed  Google Scholar 

  16. Lenzo NP, Garas G (1998) Biliary stent migration with colonic diverticular perforation. Gastrointest Endosc 47:543–544

    Article  PubMed  CAS  Google Scholar 

  17. Wurbs D (1998) The development of biliary drainage and stenting. Endoscopy 30:A202–A206

    Article  PubMed  CAS  Google Scholar 

  18. Lee MJ, Mueller PR, Saini S, Morrison MC, Brink JA, Hahn PF (1990) Occlusion of biliary endoprostheses: presentation and management. Radiology 176:531–534

    PubMed  CAS  Google Scholar 

  19. Lowe GM, Bernfield JB, Smith CS, Matalon TA (1990) Gastric pneumatosis: sign of biliary stent-related perforation. Radiology 174(3 Pt 2):1037–1038

    PubMed  CAS  Google Scholar 

  20. Mueller PR, Ferrucci JT Jr, Teplick SK, van Sonnenberg E, Haskin PH, Butch RJ, Papanicolaou N (1985) Biliary stent endoprosthesis: analysis of complications in 113 patients. Radiology 156:637–639

    PubMed  CAS  Google Scholar 

  21. Lahoti S, Catalano MF, Geenen JE, Schmalz MJ (1998) Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center. Gastrointest Endosc 47:486–491

    Article  PubMed  CAS  Google Scholar 

  22. Baty V, Denis B, Bigard MA, Gaucher P (1996) Sigmoid diverticular perforation relating to the migration of a polyethylene endoprosthesis. Endoscopy 28(9):781

    Article  PubMed  CAS  Google Scholar 

  23. Johanson JF, Schmalz MJ, Geenen JE (1992) Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 38:341–346

    Article  PubMed  CAS  Google Scholar 

  24. Tarnasky PR, Cotton PB, Baillie J, Branch MS, Affronti J, Jowell P, Guarisco S, England RE, Leung JW (1995) Proximal migration of biliary stents: attempted endoscopic retrieval in forty-one patients. Gastrointest Endosc 42:513–520

    Article  PubMed  CAS  Google Scholar 

  25. Chaurasia OP, Rauws EA, Fockens P, Huibregtse K (1999) Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience. Gastrointest Endosc 50:780–785

    Article  PubMed  CAS  Google Scholar 

  26. Schmalz MJ, Johanson JF, Geenen JE, Venu RP, Johnson GK (1991) Migrated biliary and pancreatic stents; complications and techniques for retrieval (abstract). Gastrointest Endosc 37:252

    Google Scholar 

  27. Lammer J (1990) Biliary endoprostheses. Plastic versus metal stents. Radiol Clin North Am 28:1211–1222

    PubMed  CAS  Google Scholar 

  28. Parlak E, Cicek B, Koruk I, Disibeyaz S, Sahin B (2005) Successful prevention of stent migration caused by placement of a second stent. Endoscopy 37:404

    Article  PubMed  CAS  Google Scholar 

  29. Tringali A, Mutignani M, Perri V, Zuccala G, Cipolletta L, Bianco MA, Rotondano G, Philipper M, Schumacher B, Neuhaus H, Schmit A, Deviere J, Costamagna G (2003) A prospective, randomized multicenter trial comparing double Layer and polyethylene stents for malignant distal common bile duct strictures. Endoscopy 35:992–997

    Article  PubMed  CAS  Google Scholar 

  30. Guitron A, Adalid R, Barinagarrementeria R, Gutierrez-Bermudez JA, Martinez-Burciaga J (2000) Incidence and relation of endoscopic sphincterotomy to the proximal migration of biliary prostheses. (abstract). Rev Gastroenterol Mex 65:159–162

    PubMed  CAS  Google Scholar 

  31. Alfredo G, Raul A, Barinagarrementeria R, Gutierrez-Bermudez JA, Martinez-Burciaga J (2001) Proximal migration of biliary prosthesis. Endoscopic extraction techniques. (abstract). Rev Gastroenterol Mex 66:22–26

    PubMed  CAS  Google Scholar 

  32. Barton RJ (2006) Migrated double pigtail biliary stent causes small bowel obstruction. J Gastroenterol Hepatol 21:783–784

    Article  PubMed  CAS  Google Scholar 

  33. Soderlund C, Linder S (2006) Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc 63(7):986–995

    Article  PubMed  Google Scholar 

  34. Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K (1992) Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340:1488–1492

    Article  PubMed  CAS  Google Scholar 

  35. Kaassis M, Boyer J, Dumas R, Ponchon T, Coumaros D, Delcenserie R, Canard JM, Fritsch J, Rey JF, Burtin P (2003) Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57(2):178–182

    Article  PubMed  Google Scholar 

  36. Larghi A, Tringali A, Lecca PG, Giordano M, Costamagna G (2008) Management of hilar biliary strictures. Am J Gastroenterol 103:458–473

    Article  PubMed  Google Scholar 

  37. Giorgio PD, Luca LD (2004) Comparison of treatment outcomes between biliary plastic stent placements with and without endoscopic sphincterotomy for inoperable malignant common bile duct obstruction. World J Gastroenterol 10:1212–1214

    PubMed  Google Scholar 

  38. Margulies C, Siqueira ES, Silverman WB, Lin XS, Martin JA, Rabinovitz M, Slivka A (1999) The effect of endoscopic sphincterotomy on acute and chronic complications of biliary endoprostheses. Gastrointest Endosc 49:716–719

    Article  PubMed  CAS  Google Scholar 

  39. Barton RJ (2006) Migrated double pigtail biliary stent causes small bowel obstruction. J Gastroenterol Hepatol 21(4):783–784

    Article  PubMed  CAS  Google Scholar 

  40. Simpson D, Cunningham C, Paterson-Brown S (1998) Small bowel obstruction caused by a dislodged biliary stent (abstract). J R Coll Surg Edinb 43(3):203

    PubMed  CAS  Google Scholar 

  41. Saranga Bharathi R, Rao P, Ghosh K (2006) Iatrogenic duodenal perforations caused by endoscopic biliary stenting and stent migration: an update. Endoscopy 38(12):1271–1274

    Article  PubMed  CAS  Google Scholar 

  42. Miller G, Yim D, Macari M, Harris M, Shamamian P (2005) Retroperitoneal perforation of the duodenum from biliary stent erosion. Curr Surg 62(5):512–515

    Article  PubMed  Google Scholar 

  43. Marsman JW, Hoedemaker HP (1996) Necrotizing fasciitis: fatal complication of migrated biliary stent. Australas Radiol 40(1):80–83

    Article  PubMed  CAS  Google Scholar 

  44. Anderson EM, Phillips-Hughes J, Chapman R (2007) Sigmoid colonic perforation and pelvic abscess complicating biliary stent migration. Abdom Imaging 32(3):317–319

    Article  PubMed  Google Scholar 

  45. Tzovaras G, Liakou P, Makryiannis E, Paroutoglou G (2007) Acute appendicitis due to appendiceal obstruction from a migrated biliary stent. Am J Gastroenterol 102(1):195–196

    Article  PubMed  Google Scholar 

  46. Soto-Avila JJ, Gómez-Wong ME, Preciado-Hernández F (2006) Colovesical fistula secondary to the migration of a biliary stent (abstract). Cir Cir 74(6):473–475

    PubMed  Google Scholar 

  47. Wilhelm A, Langer C, Zoeller G, Nustede R, Becker H (2003) Complex colovesicular fistula: A severe complication caused by biliary stent igration. Gastrointest Endosc 57(1):124–126

    Article  PubMed  Google Scholar 

  48. Blake AM, Monga N, Dunn EM (2004) Biliary stent causing colovaginal fistula: case report. JSLS 8(1):73–75

    PubMed  Google Scholar 

  49. Figueiras RG, Echart MO, Figueiras AG, González GP (2001) Colocutaneous fistula relating to the migration of a biliary stent. Eur J Gastroenterol Hepatol 13(10):1251–1253

    Article  PubMed  CAS  Google Scholar 

  50. Karim A, Orbell JH, Bhatti K, Chaudhary B, Parvaiz A (2006) Biliary stent migration presenting as a recurrent abdominal wall abscess with underlying enterocutaneous fistula. Gastrointest Endosc 63(6):874–876

    Article  PubMed  Google Scholar 

  51. Basile A, Macri’ A, Lamberto S, Caloggero S, Versaci A, Famulari C (2003) Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent. Gastrointest Endosc 57(1):136–138

    Article  PubMed  Google Scholar 

  52. Ang BK, Wee SB, Kaushik SP, Low CH (1998) Duodenal-colic fistula resulting from migration of a biliary stent: a case report. Gastrointest Endosc 48(1):80–83

    Article  PubMed  CAS  Google Scholar 

  53. Liebich-Bartholain L, Kleinau U, Elsbernd H, Büchsel R (2001) Biliary pneumonitis after proximal stent migration. Gastrointest Endosc 54(3):382–384

    Article  PubMed  CAS  Google Scholar 

  54. Shah OJ, Khan FA, Robanni I, Wani NA (2004) Hepatic perforation: a complication of proximal biliary stent migration. Endoscopy 36(11):1040

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Yunus Emre caddesi, Yigitler sokak, 9/3, Incirli, Ankara, Turkey

    Mehmet Arhan

  2. Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey

    Mehmet Arhan, Bülent Ödemiş, Erkan Parlak & İbrahim Ertuğrul

  3. Yıldırım Beyazıt Education Hospital, Ankara, Turkey

    Ömer Başar

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  1. Mehmet Arhan
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  2. Bülent Ödemiş
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Correspondence to Mehmet Arhan.

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Arhan, M., Ödemiş, B., Parlak, E. et al. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc 23, 769–775 (2009). https://doi.org/10.1007/s00464-008-0067-x

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  • DOI: https://doi.org/10.1007/s00464-008-0067-x

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