Bülent ÖDEMİŞ, Orhan ÇOŞKUN, Erkin ÖZTAŞ, Fatih SAYGILI, Muhammet Yener AKPINAR

Deforme biliyer metal stente bağlı gelişen gastrointestinal sistem kanaması

Kanama, endoskopik retrograd kolanjiyopankreatografinin (ERCP) ciddi komplikasyonlarından biri olup insidansı %12 arasında değişir. Kanama sıklıkla endoskopik sfinkterotomi ile ilişkilidir, bununla beraber vaka serilerinde sfinkterotomi ilişkisiz kanamalar da bildirilmiştir. Biliyer metal stentin barsak duvarında yaptığı irritasyona bağlı oluşan kanamalar sfinkterotomi ilişkisiz kanamalara örnek gösterilebilir. Biliyer stent öyküsü olan hastaların stentin olduğu yerde ağrı ile gelmesi stentin barsak duvarına yaptığı irritasyonu akla getirir. Literatürde migre olmadan deformasyonla barsak duvarı irritasyonu yapan ve kanamaya yol açan biliyer metal stent görülmemiştir. Burada öncesinden ERCP ile biliyer metal stent konulan ve metal stentin deformasyonuna bağlı duodenumda oluşan ülserin yol açtığı kanama ile gelen hastamızı sunduk.

Gastrointestinal bleeding due to deformed biliary stent

Hemorrhage is a severe complication of endoscopic retrograde cholangiopancreatography (ERCP) with 1-2% frequency. Hemorrhage is usually related to spinhcterotomy, however some case reports demonstrated that hemorrhagic complications are not related to sphincterotomy. Hemorrhage due to bowel wall irritation of biliary metal stent can be an example for this kind of bleedings. Pain at the site of stent must be considered for bowel wall irritation in patients with biliary stent history. In the literature hemorrhage due to bowel wall irritation associated with deformed metal stent was not reported. Here we presented our case with gastrointestinal hemorrhage due to duodenal ulcer associated with deformed biliary metal stent irritation.

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1. Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol 2016;30(5):793-805.
2. Lee MH, Tsou YK, Lin CH, et al. Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding. World J Gastroenterol 2016;22(11):3196-201.
3. Jiménez-Pérez M, Melgar Simón JM, Durán Campos A, González Grande R, Rodrigo López JM, Manteca González R. Endoscopic management of post-liver transplantation biliary strictures with the use of fully covered metallic stents. Transplant Proc 2016;48(7):2510-4.
4. Menon S. Hilar stenting for malignant biliary obstruction. Gastrointest Endosc 2016;83(2):478-9.
5. Pfau PR, Pleskow DK, Banerjee S, et al. Pancreatic and biliary stents. ASGE Technology Assessment Committee. Gastrointest Endosc 2013;77(3):319-27.
6. Yu DW, Hong MY, Hong SG. Endoscopic treatment of duodenal fistula after incomplete closure of ERCP-related duodenal perforation. World J Gastrointest Endosc 2014 16;6(6):260-5.
7. Inoue T, Naitoh I, Okumura F, et al. Reintervention for stent occlusion after bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction. Dig Endosc 2016 ;28(7):731-7.
8. Togawa O, Kawabe T, Isayama H, et al. Management of occluded uncovered metallic stents in patients with malignant distal biliary obstructions using covered metallic stents. J Clin Gastroenterol 2008;42(5):546-9.
9. Ho H, Mahajan A, Gosain S, et al. Management of complications associated with partially covered biliary metal stents. Dig Dis Sci 2010;55(2):516-22.
10. Christiaens P, Decock S, Buchel O, et al. Endoscopic trimming of metallic stents with the use of argon plasma. Gastrointest Endosc 2008;67(2):369-71.