Biliary stent migration after cholecystectomy following a single-preoperative ERCP: insights into real-world bile...

Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement is commonly employed in patients with choledocholithiasis as part of a staged perioperative management strategy. In clinical practice, biliary stent migration is often observed at the time of planned postoperative ERCP. Characterizing the occurrence of biliary stent migration, its associated clinical factors, and its implications for postoperative management is therefore relevant to optimizing patient care.

We conducted a single-center retrospective cohort study including adult patients who underwent a single preoperative ERCP with biliary plastic stent placement, followed by cholecystectomy and a planned postoperative ERCP for stent removal between 2012 and 2023. The primary outcome was biliary stent migration, defined as absence of the stent at postoperative ERCP, confirmed endoscopically and fluoroscopically. Demographic, clinical, and procedural variables were analyzed to explore factors associated with stent migration.

A total of 208 patients were included. Biliary stent migration was observed in 51 patients (24.5%). At postoperative ERCP, choledocholithiasis was identified in 67.8% of cases. In univariate analysis, pancreatic stent placement during the index ERCP was associated with lower odds of biliary stent migration; however, this association did not remain statistically significant after multivariable adjustment. No other demographic or procedural factors were independently associated with migration.

Individualized approach may be applied for selective patients referred to the biliary stent removal after cholecystectomy. Abdominal imaging before postoperative ERCP in asymptomatic patients with normal liver function tests may help in the decision-making process and potentially prevent unnecessary invasive procedures and reduce its complications.