Cholecystocolonic fistula resulting from biliary stent migration.

BACKGROUND AND AIMS: Patients may require biliary stent placement for cholecystitis, but stent dislocation rarely results in colonic perforation. We describe a patient whose biliary stent dislodged between the transverse colon and gallbladder, creating a fistula. We aim to highlight the importance of early recognition and describe a minimally invasive approach to fistula closure. METHODS: We used a novel technique using simultaneous bidirectional endoscopy, performing colonoscopy and ERCP concurrently to repair a cholecystocolonic fistula caused by biliary stent migration. RESULTS: This combined approach enabled direct visualization of the fistula via the colonoscope, allowing precise grasping and closure of the fistulous tract during the withdrawal of the biliary stent through the ERCP scope. During the same session, the eroding biliary plastic stent was replaced, minimizing procedure time and anesthesia exposure to the patient. CONCLUSIONS: Simultaneous bidirectional endoscopy can be considered an effective approach to the management of biliary-enteric fistulas. This technique allows closure under direct visualization while addressing the underlying stent in a single session. This approach has the potential to reduce adverse events by avoiding surgical interventions. Wider adoption of this technique may benefit select patients with similar presentations.