Outcomes of Prolonged Biliary Plastic Stent Dwell Time in Patients with Choledocholithiasis Undergoing ERCP Followed...

Introduction: ERCP with temporary biliary stenting followed by elective cholecystectomy and postoperative ERCP is commonly used to treat choledocholithiasis. While early stent removal (within 3-6 months) is generally recommended, some studies suggest that longer dwell time may not increase morbidity. This study aims to evaluate outcomes associated with prolonged stent dwell time of more than six months. Methods: We conducted a retrospective study of all patients who underwent ERCP with plastic biliary stent insertion, followed by elective cholecystectomy and postoperative ERCP at a single tertiary center between 2018-2024. Patients were divided into early-ERCP (≤6 months) and late-ERCP (>6 months) groups. The primary outcome was the rate of recurrent biliary episodes. Secondary outcomes included urgent postoperative ERCP, stent reinsertion, and the need for additional ERCP's. Results: A total of 203 patients were included (mean age 58.3 ± 19.8 years). Thirty-one patients (15%) had a stent dwell time of more than six months. Demographic and presenting characteristics were comparable between groups, except for acute cholecystitis, which was more frequent in the early-ERCP group (18% vs. 3.2%, p = 0.034). Recurrent biliary episodes were significantly more frequent in the late-ERCP group (19.4% vs. 5.8%, p = 0.021), as were urgent postoperative ERCP (16.1% vs. 5.2%, p = 0.044), stent reinsertion (35.5% vs. 14.5%, p = 0.008), and additional ERCPs (38.7% vs. 15.7%, p = 0.006). Conclusions: Prolonged biliary stent dwell time beyond six months is associated with significantly higher rates of recurrent biliary episodes, urgent postoperative ERCP, postoperative stent reinsertion, and additional ERCP's.