From the Guidelines
The rate of migration of Axios stents after choledochoduodenostomy is approximately 5-10% of cases, as reported in recent studies 1. Migration typically occurs within the first 4-8 weeks after placement. When migration happens, it can lead to complications such as biliary leakage, obstruction, or peritonitis requiring immediate intervention. Factors that increase migration risk include:
- Improper initial stent deployment
- Anatomical variations
- Premature dissolution of the lumen-apposing properties To minimize migration risk, proper stent selection (typically 6-10mm diameter with appropriate lumen-apposing features) and precise deployment technique are essential. Regular follow-up imaging at 2-4 week intervals after placement is recommended to monitor stent position. If migration is detected, prompt endoscopic or surgical intervention is necessary. The Axios stent's design with wide flanges on both ends theoretically reduces migration risk compared to traditional plastic stents, but vigilance is still required throughout the intended stent indwelling period, which typically ranges from 1-3 months depending on the specific clinical indication, as suggested by the use of self-expanding metal stents (SEMS) for pseudo-cyst drainage 1.
The use of metal stents may offer several potential advantages to drainage of pseudocysts, including improved drainage with a larger diameter stent, reduced risk of stent obstruction, direct endoscopic access to the collection, reduced number of instrumental changes and possibly reduced procedural time 1. However, the frequency of stent migration is much higher with covered metallic stents as compared to uncovered metallic stents 1. Therefore, the choice of stent type and size should be carefully considered to minimize the risk of migration and ensure optimal patient outcomes, with a focus on reducing morbidity, mortality, and improving quality of life.
From the Research
Rate of Migration of AXIOS Stent after Choledoduodenostomy
- The rate of migration of AXIOS stent after choledoduodenostomy is reported to be around 9.3% in one study 2.
- This study found that out of 54 patients with clinical success, 5 patients required re-intervention for stent migration or other complications.
- Another study reported a case of AXIOS stent migration into the colon, highlighting the potential for stent migration despite its design to prevent this 3.
- The study found that conservative management was feasible in this case, and the patient was able to pass the stent through their bowel motions without issue.
- Other studies have reported cases of biliary stent migration, including into the abdominal wall 4 and causing bowel obstruction 5.
- However, one study found that choledochoduodenostomy is a safe and effective method of decompressing the distal common bile duct in benign pancreatobiliary disease, with a low incidence of complications such as sump syndrome 6.
Complications of AXIOS Stent Migration
- Stent migration can lead to complications such as pancreatitis, small bowel perforation, and peritonitis 4.
- In one case, AXIOS stent migration into the colon was managed conservatively, and the patient was able to pass the stent through their bowel motions without issue 3.
- Other complications of AXIOS stent migration may include abdominal wall abscess, as reported in one case study 4.
- Closer monitoring of patients with biliary prostheses is needed to prevent stent migration and its consequent serious complications 4.