Biliary Stent Migration: A Therapeutic Challenge

Biliary stenting is a commonly performed procedure and is usually uneventful. Stent migration is an uncommon event but its management can pose a therapeutic challenge to the endoscopist. Though majority of migrated plastic stents can be retrieved by therapeutic endoscopists, some require surgical intervention. We report two such cases of biliary plastic stent migration in which endoscopic retrieval either failed or was contraindicated. Both patients had previously undergone sphincterotomy and 10Fr plastic biliary stent placement. The first case of proximal stent migration resulted in impaction of proximal stent flap into one of the side branches of the left hepatic duct. In second case distally migrated setnt had perforated across the duodenal wall resulting in peritonitis necessitating emergency laparotomy. We have discussed different endoscopic maneuvers for retrieval of migrated biliary stents and reviewed the role of surgery in such complicated scenarios. (J Dig Endosc 2010;1:19-21)