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Prophylactic biliary stenting post-ERCP prior to cholecystectomy: a systematic review and meta-analysis
Zahid Ijaz Tarar1, Mustafa Gandhi2, Umer Farooq3
1Department of Gastroenterology and Hepatology, School of Medicine, University of Missouri, 1 Hospital Dr, Columbia, MO, 65212, USA. drzahidejaz@hotmail.com.
Surgical Endoscopy
|July 13, 2026
Summary
Prophylactic biliary stenting after ERCP for choledocholithiasis in patients awaiting cholecystectomy did not reduce recurrent stones but increased repeat ERCP and acute cholecystitis risks. Therefore, routine prophylactic stenting is not recommended.
Area of Science:
- Gastroenterology
- Biliary Endoscopy
- Surgical Outcomes
Background:
- Standard practice for difficult common bile duct (CBD) stone retrieval post-ERCP involves plastic stent placement.
- Clear guidelines are lacking for prophylactic biliary stenting in patients with choledocholithiasis awaiting cholecystectomy after complete stone extraction.
Purpose of the Study:
- To compare outcomes in patients who received prophylactic biliary stenting versus no stenting after ERCP for choledocholithiasis, when cholecystectomy is pending.
- To evaluate the impact of prophylactic stenting on recurrent choledocholithiasis, repeat ERCP, cholangitis, pancreatitis, and acute cholecystitis.
Main Methods:
- A systematic literature search was conducted across multiple databases (PubMed/Medline, Embase, Scopus, CINAHL, Web of Science, Cochrane).
- Included studies compared outcomes of prophylactic biliary stenting versus no stenting in patients with choledocholithiasis awaiting cholecystectomy post-ERCP.
- Key outcomes assessed included recurrent choledocholithiasis, repeat ERCP, cholangitis, pancreatitis, and acute cholecystitis.
Main Results:
- 10 studies involving 1259 patients were analyzed; 692 received prophylactic stents.
- No significant difference in recurrent choledocholithiasis rates (6.9% vs. 13.9%) was observed between groups.
- Prophylactic stenting significantly increased the odds of repeat ERCP (OR 3.13) and acute cholecystitis (OR 2.53), with no difference in cholangitis or pancreatitis.
Conclusions:
- Prophylactic biliary stenting in post-ERCP patients with choledocholithiasis awaiting cholecystectomy does not decrease recurrent stone rates.
- Stenting is associated with higher risks of repeat ERCP and acute cholecystitis.
- Routine prophylactic stent placement in this patient group is not recommended.
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