Stassen Pauline M C, de Jong David M, Poley Jan-Werner, Bruno Marco J, de Jonge Pieter J F
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Endosc Int Open. 2021 Mar;9(3):E461-E469. doi: 10.1055/a-1337-2321. Epub 2021 Feb 19.
The safety of transpapillary biliary drainage by stent placement through endoscopic retrograde cholangiography (ERC) may be compromised by the occurrence of stent migration-induced perforation of the duodenal wall (SMDP). We aimed to assess the prevalence rate, risk factors and clinical course of SMDP. This retrospective cohort study included all patients who underwent an ERC with biliary plastic stent placement, between January 2014 and December 2018. Patients with an SMDP were identified from our endoscopy complication registry. 1227 patients underwent an ERC, of whom 629 patients (51 %) with biliary plastic stent placement; in 304 patients (25 %) stents were placed for perihilar strictures. Thirteen patients with SMDP were identified. The prevalence was 2.1 % for patients with biliary plastic stent placement and 4.3 % for patients stented for a perihilar stricture. All SMDPs occurred in patients with a perihilar stricture and with stents ≥ 12 cm (range 12-20 cm). Another potential risk factor was stent insertion into the left liver lobe, which was present in 10 of 13 patients. In 10 of 13 patients, SMDP was clinically suspected. Three of 13 patients were asymptomatic and diagnosed at elective stent retrieval. Eight patients could be endoscopically treated with an over-the-scope clip. Four patients died due to abdominal sepsis despite repeated interventions. SMDP is a rare but potentially life-threatening complication of ERC after transpapillary drainage for perihilar biliary strictures. Stents ≥ 12 cm and stent insertion into the left liver lobe may be associated risk factors.
经内镜逆行胆管造影术（ERC）置入支架进行经乳头胆管引流的安全性，可能会因支架移位导致十二指肠壁穿孔（SMDP）而受到影响。我们旨在评估SMDP的发生率、危险因素及临床病程。这项回顾性队列研究纳入了2014年1月至2018年12月期间所有接受ERC并置入胆道塑料支架的患者。通过我们的内镜并发症登记系统确定了发生SMDP的患者。1227例患者接受了ERC，其中629例（51%）置入了胆道塑料支架；304例（25%）患者因肝门周围狭窄置入支架。确定了13例发生SMDP的患者。胆道塑料支架置入患者的发生率为2.1%，因肝门周围狭窄置入支架患者的发生率为4.3%。所有SMDP均发生在肝门周围狭窄且支架长度≥12 cm（范围12 - 20 cm）的患者中。另一个潜在危险因素是支架置入左肝叶，13例患者中有10例存在此情况。13例患者中有10例临床上怀疑发生了SMDP。13例患者中有3例无症状，在择期取出支架时被诊断。8例患者可通过内镜用套扎夹治疗。尽管进行了反复干预，仍有4例患者因腹腔感染死亡。SMDP是肝门周围胆管狭窄经乳头引流后ERC的一种罕见但可能危及生命的并发症。支架长度≥12 cm以及支架置入左肝叶可能是相关危险因素。
