Supplementary Material for: Case Report: Successful closure of chronic colonic double perforation caused by a plastic biliary stent with OTSC

Introduction: Biliary stenting is commonly used for managing bile duct conditions, with stent migration occurring in up to 21% of cases. Colonic perforation from stent migration is rare, typically managed surgically or with conventional endoscopic clips. The use of over-the-scope clips (OTSCs) for such perforations is less documented.
Case Presentation: An 89-year-old woman presented with abdominal pain and new-onset constipation. Imaging revealed a migrated biliary stent causing sigmoid colon perforation. One year earlier, the stent had been placed for choledocholithiasis. Due to the patient’s general condition, endoscopic removal of the stent and OTSC closure of the perforations was decided and successfully performed, with no complications on follow-up.
Conclusion: This case demonstrates the successful use of OTSCs for closing a chronic colonic perforation caused by a migrated biliary stent in a multimorbid patient. OTSCs may be a viable, less invasive alternative to surgery in similar cases.

引言：胆道支架置入术（biliary stenting）是治疗胆管疾病的常用手段，支架移位（stent migration）的发生率最高可达21%。由支架移位引发的结肠穿孔（colonic perforation）较为罕见，临床通常采用外科手术或常规内镜夹进行处理。而镜下夹（over-the-scope clips，OTSCs）应用于此类穿孔的相关文献报道相对较少。

病例报告：1例89岁女性因腹痛及新发便秘就诊。影像学检查显示移位的胆道支架引发乙状结肠穿孔。该患者1年前因胆总管结石（choledocholithiasis）置入胆道支架。鉴于患者的整体身体状况，临床最终决定并成功实施内镜下支架取出术联合OTSCs闭合穿孔，随访期间未出现任何并发症。

结论：本病例证实，对于多病共存患者（multimorbid patient）因移位胆道支架引发的慢性结肠穿孔，采用OTSCs进行闭合治疗可取得成功。在类似病例中，OTSCs或可成为一种可行且创伤更小的外科手术替代方案。