Gastric Outlet Obstruction Caused by a Migrated Biliary Stent: A Review of Published Cases
DOI:
https://doi.org/10.5281/zenodo.22279192Keywords:
Biliary stent, Stent migration, Gastric outlet obstruction, Duodenal obstruction, Endoscopic retrievalAbstract
Background: Biliary stent migration is the commonest mechanical failure of endoscopic stenting. Gastric outlet obstruction
appears in complication lists and individual reports but has never been counted. Objective: To set out what the published record contains on gastric outlet obstruction from a migrated stent, against the well-measured parent complication.
Methods: Narrative review of published cohort studies, pooled case analyses and individual case reports.Findings: Migration rates across cohorts were consistent, from 74 of 876 stented patients (8.4%) to 11.4% of 295 plastic stents. Only three published records involve the gastroduodenal outlet, and in all three the duodenum was narrowed by tumour, so the stent was not clearly the obstructing object. No study reports a denominator for this complication. Conclusions: The published record supports imaging the vomiting patient and searching widely for the stent; it does not support any rate for outlet obstruction, which remains reported and unmeasured.
References
Johanson, J.F., Schmalz, M.J., Geenen, J.E. (1992) Incidence and risk factors for biliary and pancreatic stent migration. Gastrointestinal Endoscopy, 38(3): 341-346.
Arhan, M., Odemis, B., Parlak, E., Ertugrul, I., Basar, O. (2009) Migration of biliary plastic stents: experience of a tertiary center. Surgical Endoscopy, 23(4): 769-775.
Emara, M.H., Ahmed, M.H., Mohammed, A.S., Radwan, M.I., Mahros, A.M. (2021) Biliary stent migration: why, how, and what? European Journal of Gastroenterology and Hepatology, 33(7): 967-973.
Duman, A.E., Hulagu, S. (2022) Management of migrated plastic biliary stents in patients with benign biliary diseases. Laparoscopic Endoscopic Surgical Science, 29(1): 29-35.
Yuan, X.L., Ye, L.S., Liu, Q., Wu, C.C., Liu, W., Zeng, X.H., et al. (2020) Risk factors for distal migration of biliary plastic stents and related duodenal injury. Surgical Endoscopy, 34(4): 1722-1729.
Namdar, T., Raffel, A.M., Topp, S.A., Namdar, L., Alldinger, I., Schmitt, M., et al. (2007) Complications and treatment of migrated biliary endoprostheses: a review of the literature. World Journal of Gastroenterology, 13(40): 5397-5399.
Stassen, P.M.C., de Jong, D.M., Poley, J.W., Bruno, M.J., de Jonge, P.J.F. (2021) Prevalence of and risk factors for stent migration-induced duodenal perforation. Endoscopy International Open, 9(3): E461-E469.
Zorbas, K.A., Ashmeade, S., Lois, W., Farkas, D.T. (2021) Small bowel perforation from a migrated biliary stent: a case report and review of literature. World Journal of Gastrointestinal Endoscopy, 13(10): 543-554.
Kawaguchi, Y., Ogawa, M., Kawashima, Y., Mizukami, H., Maruno, A., Ito, H., et al. (2014) Risk factors for proximal migration of biliary tube stents. World Journal of Gastroenterology, 20(5): 1318-1324.
Kale, A., Sundaram, S., Aggarwal, M., Giri, S., Darak, H., Jain, G., et al. (2024) Predictors of proximal migration of straight biliary plastic stents. Indian Journal of Gastroenterology, 43(3): 592-600.
Tringali, A., Hassan, C., Rota, M., Rossi, M., Mutignani, M., Aabakken, L. (2018) Covered vs. uncovered self-expandable metal stents for malignant distal biliary strictures: a systematic review and meta-analysis. Endoscopy, 50(6): 631-641.
Lam, R., Muniraj, T. (2021) Fully covered metal biliary stents: a review of the literature. World Journal of Gastroenterology, 27(38): 6357-6373.
Ki, S.H., Jeong, S., Lee, D.H., Lee, J.I., Lee, J.W., Kim, H.G., et al. (2008) Migration of a biliary self-expanding metal stent into the stomach after stent placement in a patient with periampullary cancer. Korean Journal of Gastrointestinal Endoscopy, 36(5): 324-328.
Katakura, Y., et al. (2012) Late migration of covered metal stent to the stomach through a spontaneous choledochoduodenal fistula in a patient with malignant biliary obstruction. Gastroenterology Research, 5(3): 133-136.
Sundaram, S., et al. (2022) Endoscopic retrieval of a blocked double-pigtail plastic biliary stent through an endoscopic ultrasound-guided gastrojejunostomy in a patient with gastric outlet obstruction. Endoscopy, 54(S 02): E806-E807.
Vallabh, H., Shah-Khan, S., Hsueh, W., Nasr, J. (2017) Removal of migrated biliary stent by use of an enteral stent in a patient with gastric outlet obstruction caused by nonresectable pancreatic adenocarcinoma with prior loop gastrojejunostomy. VideoGIE, 2(8): 195-196.
Nudelman, B.G., Cortes, M., Khella, R., et al. (2024) Bowel obstruction from biliary stent migration: an unusual case of abdominal pain. Cureus, 16(1): e52257.
Garg, K., Zagzag, J., Khaykis, I., Liang, H. (2011) Surgical relief of small bowel obstruction by migrated biliary stent: extraction without enterotomy. JSLS, 15(2): 232-235.
Ikeda, T., Nagata, S., Ohgaki, K. (2004) Intestinal obstruction because of a migrated metallic biliary stent. Gastrointestinal Endoscopy, 60(6): 988-989.
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.
Jadallah, K., Alzubi, B., Sweidan, A., et al. (2019) Intraperitoneal duodenal perforation secondary to early migration of biliary stent: closure with through-the-scope clip. BMJ Case Reports, 12(9): e230324.
Warnock, G.L., et al. (2013) A potentially fatal complication of biliary stent migration. Journal of Medical Cases, 4(1): 49-51.
Wang, X., Qu, J., Li, K. (2020) Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature. BMC Gastroenterology, 20(1): 149.
Desai, M.Z.J.H., et al. (2025) Endoscopic retrieval of a migrated biliary stent causing duodenal perforation in a patient with Mirizzi syndrome. Cureus, 17(11): e96339.
Chotrani, M., Rathi, P., Borle, N., Chandnani, S. (2025) Distally migrated plastic biliary stent leading to spontaneous small bowel perforation. Medical Journal Armed Forces India, in press.
Siaperas, P., Ioannidis, A., Skarpas, A., Angelopoulos, A., Drikos, I., Karanikas, I. (2017) A rare cause for Hartmann's procedure due to biliary stent migration: a case report. International Journal of Surgery Case Reports, 31: 32-34.
Katsinelos, P., Kountouras, J., Paroutoglou, G., Chatzimavroudis, G., Paikos, D., Zavos, C., et al. (2009) Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers. Surgical Laparoscopy Endoscopy and Percutaneous Techniques, 19(3): 217-221.
