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.