Tu1048 PREVALENCE AND RISK FACTORS FOR DUODENAL PERFORATION DUE TO MIGRATED BILIARY PLASTIC STENTS

Abstract

Transpapillary biliary drainage by stent placement through endoscopic retrograde cholangiography (ERC) is a well-established treatment for bile duct obstruction. Migrated-stent-induced duodenal perforation (MSDP) can be a life-threatening complication. The actual prevalence of MSDP is however unknown and risk factors are unclear. We aimed to analyze the prevalence, risk factors and clinical course of MSDP. All patients who underwent an ERC with biliary plastic stent placement between January 1st 2014 and December 31st 2017 in our centre were retrospectively analysed. General patient characteristics, ERC indication and biliary stricture and stent characteristics were collected. For patients with a MSDP, date of perforation, clinical presentation, type of treatment and outcome were reviewed. A total of 2487 ERCs were performed in 1228 patients (mean age 59 years, 59% male). In 630 patients (51%) a biliary plastic stent was placed; in 304 patients (25%) one or more stents were placed for perihilar strictures. A total of 14 MSDPs were diagnosed in 13 patients (mean age 63 years, 79% male). All MSDPs occurred in patients with a perihilar stricture. The overall prevalence was 1,1% in all patients, 2,1% for patients with biliary stent placement and 4,3% for patients with a stent for perihilar stricture. Perforation did not occur with stents shorter than 12 cm (median length 15 cm, IQR 12-15 cm). Perforation occurred both with 7 and 10 French stents (21% and 79% resp.) and with either centre or duodenal bend type stents (42% and 58% resp.). Etiology of stenosis was malignant in 8 patients (57%). In 57% of patients the proximal tip was deployed in the left intrahepatic ducts. Median time to diagnosis of MSDP was 12 days (IQR 4-66 days). In 9/13 patients MSDP was clinically suspected due to presentation with abdominal pain, fever and/or laboratory abnormalities. 4/13 patients were asymptomatic and were diagnosed at elective stent retrieval. Treatment was either by stent removal (n=4), endoscopic closure with an over the scope clip (n=8) or surgery (n=1). 4/13 patients died due to abdominal sepsis despite repeated interventions. This is the first study to report on the prevalence of MSDP in patients who undergo ERC. Despite the overall low risk of MSDP, it represents a potentially life threatening complication of ERC after transpapillary drainage for perihilar biliary strictures. The risk of MSDP needs to be acknowledged for this indication and warrants consideration in symptomatic patients after ERC.