Prophylactic biliary stenting post-ERCP prior to cholecystectomy: a systematic review and meta-analysis

The standard practice is to place a plastic stent in CBD after ERCP when a stone cannot be retrieved completely, but there is no clear guidance about placing the stent in patients awaiting cholecystectomy after complete stone extraction. We compared the outcomes in patients who received prophylactic biliary stenting after ERCP was performed for choledocholithiasis with those who did not receive the stent.

We searched PubMed/Medline, Embase, Scopus, CINAHL, the Web of Science, and the Cochrane databases to identify studies that compared the outcomes of patients who received prophylactic biliary stent with no stenting after ERCP in patients with choledocholithiasis awaiting cholecystectomy. Our outcomes of interest were the odds of recurrent choledocholithiasis, repeat ERCP, cholangitis, pancreatitis, and acute cholecystitis.

We included 10 studies with 1259 patients, of which 692 received prophylactic biliary stents. A total of 32 (6.9%) cases of recurrent choledocholithiasis occurred in the stent group compared to 53 (13.9%) in the no stent group, but we found no difference in pooled odds (OR 0.55, 95%CI 0.21-1.43, I² 58%) of choledocholithiasis between groups. The odds (OR 3.13, 95%CI 1.32-7.42, I² 0%) of repeat ERCP was significantly higher in the stent group. We did not find any difference in the odds of acute cholangitis (OR 0.93, 95%CI 0.40-2.16, I² 39%) and pancreatitis (OR 1.31, 95%CI 0.68-2.51, I2 0%) between groups. The odds of acute cholecystitis (OR 2.53, 95% 1.01-6.38, I² 0%) were higher in the stent group.

Although there was no difference in the rate of recurrent choledocholithiasis between groups, prophylactic stent placement resulted in increased odds of repeat ERCP and acute cholecystitis. Based on these findings, we recommend against placing stents in post-ERCP patients awaiting cholecystectomy.