Clinical Outcomes of Retained Plastic Biliary Stents: A Targeted Narrative Review

Plastic biliary stents (PBS) are commonly used for temporary drainage in both benign and malignant biliary conditions. Although intended for short-term use, they are often retained beyond the recommended interval, increasing the risk of complications such as stent occlusion, stentolith formation, cholangitis, biliary sepsis, and rarely, migration with perforation. PBS typically have a patency of approximately 3 months, after which the risk of occlusion and bacterial colonization increases substantially. Current guidelines recommend removal or exchange within 3 months of index endoscopic retrograde cholangiopancreatography (ERCP) to prevent adverse events. The clinical presentation of these complications is often subtle, leading to delayed recognition and more invasive interventions. Management is complex, and may involve endoscopic, radiological, or surgical approaches. This targeted narrative review synthesizes findings from 10 retrospective studies and 33 case reports on complications of retained PBS, with an emphasis on epidemiology, etiopathogenesis, complications, interventions, and outcomes. Given the widespread use of plastic stents in clinical practice, both clinicians and patients must be aware of the potential complications, costs, and medicolegal implications associated with their use. In this review, we also propose the use of stent cards, digital trackers and reminders, and a national computerized registry to ensure timely stent removal and exchange in clinical practice.