A333 REMOVAL OF A MIGRATED BILIARY STENT IMPACTED IN THE COLONIC WALL: A CASE DESCRIPTION OF ENDOSCOPIC REPAIR.

Endoscopically placed biliary stents are commonly used for the treatment of pancreaticobiliary disorders. Plastic biliary stent migration is a complication that is well described in the literature and is estimated to occur in 5 to 10% of cases. The stents are usually expelled without incident within a few weeks if they migrate into the intestine. Perforation of the GI tract secondary to stent migration is a rare event occurring in less than 1 % of cases. Reported cases of perforation secondary to stent migration have required surgery for stent removal and repair. Advances in therapeutic endoscopy has led to an increase in potential complications including iatrogenic perforations. Recently, there has been an increasing interest in the use of clips and endo loops for the closure of iatrogenic colonic perforations, and for closing defects following large polypectomy Developing techniques to manage these complications is crucial to further advancement of the field. To describe a case of perforation secondary to biliary stent migration that was repaired endoscopically. Case report and review of the literature. The case is that of a 90-year-old female known for recurrent biliary obstruction secondary to gallstones and Mirizzi’s syndrome which had been managed conservatively for many years with sequential biliary stent exchanges via ERCP. The patient initially presented to hospital with sudden onset severe abdominal pain following a week of intermittent post-prandial pain. A CT scan identified a migrated biliary stent in the ascending colon with one end through the colonic wall and surrounding fat stranding, which was concerning for a perforation. The patient was admitted under the general surgery service for treatment with intravenous antibiotics and observation. Her condition stabilised and her pain subsided within 24 hours, however the stent remained lodged in the colonic wall as visualized on serial abdominal x-rays. In view of multiple comorbidities that precluded surgery, a colonoscopy was performed on day 4 of her admission. We identified the stent impacted in the wall of the ascending colon. It was dislodged with the use of a snare, leaving behind a defect in the colonic wall. We then proceeded to endoscopically close the defect with the use of 3 clips. The perforation was further approximated using an endo loop around the 3 clips, to bring the mucosa closer together. The patient recovered uneventfully and was sent home on oral antibiotics. This is the first description of a migrated plastic biliary stent removed endoscopically with repair of the colonic perforation using a previously described endoscopic technique. Our case further emphasizes the potential for endoscopic repair of gastro-intestinal perforations, especially in non-surgical candidates with multiple comorbidities. Endoscopic repair of mucosal defect using clips and an endo-loop None

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