Fishing line assisted endoscopic placement of multiple plastic biliary stents for unresectable malignant hilar biliary obstruction: a retrospective study

Background and aims Stent migration is one of the most common complications during the placement of multiple plastic biliary stents (MPBS) under endoscopy. This study aims to evaluate the feasibility and efficiency of the fishing line assisted (FLA) method for preventing the complication. Methods Patients with unresectable malignant hilar biliary obstruction (MHBO) who undergone endoscopic placement of MPBS using the FLA or conventional method from May 2018 to April 2021 in our center were enrolled in the study. The endpoints of this study were the stent migration rate, technical success rates, adverse events rates, times of stent migration, and the procedure time. Results FLA group (N = 19) and conventional group (N = 22) had similar baseline characteristics of the patients. The technical success rates (100% vs. 95.5%; P > 0.05), ERCP-related adverse events rates (5.3% vs. 4.5%; P > 0.05), and the stent-related adverse events rates (0% vs. 4.5%; P > 0.05) were no significant differences between the FLA and conventional groups. MPBS inserted using the conventional method consumed more time (median, 33.9 min vs. 15.6 min; P < 0.05) method and increased the times of stent migration (median, 3 times vs. 0 times; P < 0.05) than using the FLA method. Even if no statistical difference was detected in the stent migration rate between groups, this rate was lower in the FLA group than the conventional group (0% vs. 13.6%; P > 0.05). Conclusions FLA method is an effective technique for MPBS implantation to prevent stent migration during endoscopic retrograde cholangiography (ERCP). The method should be applied to patients with unresectable MHBO who need to place MPBS.

Acute Pancreatitis after Biliary and Pancreatic Stent Removal with a Forward-Viewing Endoscope

Plastic biliary stents are commonly used for biliary drainage, while plastic pancreatic stents may be used prophylactically against acute pancreatitis in patients at high risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. Removal of these prostheses is generally safe and can easily be performed in the ambulatory setting. Herein, we report a case of acute pancreatitis induced by removal of plastic biliary and pancreatic stents with a forward-viewing endoscope.

Perforation Due to Biliary Stent: Case Report and Review

Endoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.