Characteristics of and Risk Factors for Migration of Biliary Plastic Stents After Stone Removal With Endoscopic Retrograde Cholangiopancreatography.

Abstract

Background and Aims: Biliary plastic stents frequently detach or migrate from the duodenal papilla, leading to recurrent biliary tract infections or intestinal perforations. This study aimed to investigate the incidence and risk factors associated with migration of biliary plastic stents following endoscopic retrograde cholangiopancreatography (ERCP). Methods: The study analyzed a population of patients who underwent ERCP for bile duct stone removal and placement of biliary plastic stents between March 2018 and December 2022, and analyzed the risk factors for biliary stent migration in the enrolled patients. Results: A total of 836 patients (60.40 ± 15.58 years, 511 males) were included in the analysis. Among them, 105 patients experienced stent migration, comprising 91 (10.9%) patients with distal biliary plastic stent migration and 14 (1.7%) patients with proximal biliary plastic stent migration. Multivariate logistic regression analysis revealed that the risk of stent migration was significantly higher in patients with duodenal diverticula (odds ratio [OR] = 2.367, p = 0.005), duodenal sphincter incision (OR = 3.638, p = 0.007), and longer stent lengths (OR = 0.423, p < 0.001). The Christmas tree plastic stent exhibited a significantly lower propensity for migration compared to the straight-type biliary plastic stent (OR = 2.654, p = 0.034). In addition, the risk of proximal biliary stent migration increased significantly with the degree of balloon dilation (OR = 2.708, p = 0.043) and the presence of diverticula in the descending part of the duodenum (OR = 6.412, p = 0.002). Conclusion: Duodenal diverticulum, duodenal sphincterotomy, longer biliary stents, and straight biliary stents are independent risk factors for stent migration. In addition, balloon dilation greater than 1 cm and the presence of diverticula in the descending part of the duodenum are independent risk factors for proximal biliary stent migration. Consequently, patients with risk factors for stent migration should be closely monitored.