Bowel perforation after ERCP poses serious danger

A recent study has found that bowel perforation usually occurs within 44.5 days after endoscopic retrograde cholangiopancreatography (ERCP) and with a 10 Fr plastic biliary stent. Overall, the rate of mortality is 17.4 percent.

Researchers performed a literature search of PubMed, Embase, and Cochrane databases through October 2023 for articles reporting bowel perforation due to stent migration. Those with incomplete and proximal stent migration were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to identify eligible studies.

A total of 2,041 articles were identified, of which 92 met the eligibility criteria. Some 132 cases of bowel perforation (mean age 66 years, 56.1 percent female) due to stent migration after ERCP were recorded. The median time from initial ERCP to perforation was 44.5 days. The majority of these perforations happened in the small bowel (64.4 percent) compared with the colon (34.8 percent).

Most of the stents used were plastic (87.1 percent), with a median diameter of 10 Fr and a median length of 10.3 cm.

Surgery was performed in 52.3 percent of cases and endoscopic management in 42.4 percent. About one in four patients (25.8 percent) required bowel resection. Furthermore, the overall mortality rate stood at 17.4 percent.

“It is important for endoscopists to be mindful of this rare but serious adverse event,” the researchers said. 

Distal migration of biliary stents can occur after ERCP. Upon migration, most stents pass through the intestine without adverse events; however, bowel perforation has been reported.