OVER-THE-SCOPE CLIP FOR THE TREATMENT OF A BILIARY STENT-INDUCED DUODENAL PERFORATION

Duodenal perforation due to distal migration of plastic biliary stents is a rare ERCP complication. Endoscopic treatment options include through-the-scope and over-the-scope clips (OTSC). Surgery may be recommended, especially in cases of late (> 12 h) diagnosis or when there is contrast extravasation or intra-abdominal fluid collection. However, successful perforation closure using clips has been reported even in cases of late diagnosis. Herein, we demonstrate the successful application of a 12-mm OTSC (OVESCO, Tubingen, Germany) to treat a duodenal perforation. OTSC was applied late (> 12 h) and despite its technical success, patient’s medical condition necessitated further surgical management (laparoscopy and peritoneal lavage).