Necessity of stent placement after successful common bile duct stone clearance by endoscopic retrograde cholangiopancreatography

Abstract

Objective The aim was to evaluate the role of stent insertion in the common bile duct after complete stone clearance by endoscopic retrograde cholangiopancreatography (ERCP). Background Biliary stents are usually inserted when complete stone clearance cannot be achieved. However, stent insertion after clearance may lower the pressure in the bile ducts and provide better bile drainage, thus preventing recurrent biliary events. Patients and methods This is a prospective study that was done on a consecutive sample of 40 patients who were admitted to Menoufia University Hospital during the period between May 2016 and May 2018 with choledochocystolithiasis, who underwent complete stone clearance by ERCP. The patients were divided into two groups: group I with bile duct stent insertion and group II without bile duct stent insertion. The patients were followed up for 1 month. The complications and the outcome of the operation were recorded. Results Three cases were omitted due to failed ERCP: 10.5% of group II developed recurrent obstructive jaundice, 5.3% needed repeat emergency ERCP compared with 5.6 who developed obstructive jaundice and needed emergency ERCP in group II and 5.6% of group I developed pancreatitis. Conversion to open cholecystectomy was done only in 5.6% of group I; 11.1% of group I had downward stent migration; 5.6% had upward migration; and 5.6% had their stent occluded. Conclusion Biliary stent insertion after choledocholithiasis clearance has the disadvantage of prolonging ERCP time, increasing its cost and the stent-related complications with no advantage for this group over the group without stent insertion.