PREDICTORS OF PROXIMAL MIGRATION OF BILIARY PLASTIC STENTS : EXPERIENCE FROM HIGH VOLUME TERTIARY CARE CENTRE IN INDIA

Aims Proximal migration of biliary plastic stents (PS) remains a challenging condition to manage with need for additional manipulation in the biliary tree. Our aim was to assess predictors of internally migrated biliary plastic stents.

Methods Retrospective review of prospectively maintained endoscopy database was done from January 2016 to January 2021 to identify 1137 patients who underwent stent removal or repeat ERCP procedure. Indication, stent migration, type of stents, clinical presentation, methods of endoscopic retrieval, technical success, complications were noted and predictors of migration were analyzed.

Results Proximal migration of PS was noted in 74(6.5%) cases. Fourteen cases had distal tip above cystic duct opening, 34 had below the cystic duct opening but inside bile duct, 26 had tip at the ampulla but not seen in duodenum. Balloon catheter, basket, Sohendra stent retriever, grasping forceps, engaging sphincterotome in the stent, snare over scope were used in 46, 8, 6,5,4,1 cases respectively. Technical success for retrieval was achieved in 94.59% cases. Reasons for failure include impacted stent (2) and stent above stricture(2). Complications were haemobilia (1) and perforation (1). On univariate analysis choledocholithiasis, benign strictures, sphincteroplasty, 7 French stent, dilated bile duct and duration>3 months were associated with stent migration. [Table 1] shows results of multivariate analysis.

Table 1 showing results of multivariate logistic regression analysis.

Predictor	Odds ratio (confidence interval)	P value
Sphincteroplasty at index procedure	5.8 (2.7-12.1)	0.0005
Stent size 7 Fr	17 (6.1-30.07)	0.0005
Dilated bile duct on cholangiogram	0.347 (0.172-0.697)	0.003
Duration of stent>3 months	14 (7.9-27.001)	0.0005

Conclusions Sphincteroplasty at index procedure, dilated bile duct, stent duration>3 months, 7 Fr stent size increase the risk of internal stent migration. Migrated stents can be retrieved successfully using simple accessories in majority of the cases.

Publication History

Article published online:
14 April 2022