Can a covered biliary stent migrate?

Yes, covered biliary stents can migrate, and this is a recognized complication. Migration occurs when the stent shifts from its original position, potentially leading to bile duct obstruction or other issues.

How Common Is Migration?

The migration rate for fully covered self-expandable metal stents (FCSEMS) varies

• Approximately 20% to 40% of cases experience migration.  

• In a study involving 290 patients with distal malignant biliary obstruction, the overall migration rate was 15.2%, with 10% occurring within the first 6 months. 

Risk Factors for Migration

Several factors can increase the likelihood of stent migration:

• Stent Design: Stents with low radial force (RF) are more prone to migration.  

• Chemotherapy: Patients undergoing chemotherapy have a higher risk.  

• Duodenal Invasion: Involvement of the duodenum by the tumor can contribute to migration.

• Short Stricture Length: Strictures less than 2.2 cm in length are associated with increased migration risk.  

• Stent Design Features: Stents lacking anchoring mechanisms, such as flared ends or anchoring fins, are more susceptible to migration. 

Consequences of Migration

Migrated stents can lead to complications, including:

• Bile Duct Obstruction: Leading to jaundice or cholangitis.

• Perforation: In rare cases, migrated stents can cause perforation of the gastrointestinal tract.

• Infection: Such as cholangitis, due to impaired bile flow.

Prevention and Management

To reduce the risk of migration:

• Stent Selection: Choosing stents with higher radial force or those equipped with anchoring features can help. 

• Monitoring: Regular follow-up imaging can detect early migration.

• Endoscopic Intervention: If migration occurs, endoscopic procedures can often reposition or replace the stent.

If you have concerns about stent migration or are experiencing symptoms like abdominal pain or jaundice, it's important to consult your healthcare provider promptly.