Endoscopic resolution of a duodenal perforation due to a pancreatic stent

Dear Editor, We read with interest the article by Iñigo et al reporting the endoscopic management of a duodenal perforation. In fact we have dealt with a similar case using a different technique. A 71- year-old female patient underwent ERCP due to choledocholithiasis. After stone removal, a biliary plastic stent (9cm*10Fr) and a straight pancreatic plastic stent (6cm*5Fr) for post-ERCP pancreatitis prophylaxis were placed. The next morning the patient complained of epigastric pain and presented rebound tenderness and fever. A CT scan was ordered showing migration of the stent´s distal end through the duodenal wall to the colon. Endoscopy revealed the pancreatic stent penetrating the duodenal wall, which was removed with polypectomy snare. The perforation was closed by deploying 4 clips around the defect, which were then bundled together with an endoloop - a variation of "tulip bundle" technique. Eventually the patient was discharged. There are only few reports of pancreatic stent migration causing duodenal perforation. Regarding biliary stent duodenal perforation, it is a rare complication, occurring in less than 1%. Thus, a high level of suspicion is required, so that a timely endoscopic treatment may contribute to a favourable outcome, as shown in the two cases. Even though our technique seems to ensure a more complete closure, both are considered adequate as long as the defect is completely sealed.