Biodegradable versus plastic pancreatic stents for preventing post-ERCP pancreatitis: a multicenter propensity...

Biodegradable pancreatic stents are a potential alternative to conventional plastic stents for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), but comparative evidence remains limited. This multicenter study compared PEP incidence between biodegradable and plastic pancreatic stents using adjusted analyses to minimize confounding.

This UK multicenter retrospective study included adults receiving biodegradable or plastic pancreatic stents between January 2020 and September 2025. Baseline differences were addressed using propensity score-based inverse probability of treatment weighting (IPTW). The primary outcome was PEP, analyzed using IPTW-adjusted risk differences with bootstrap confidence intervals.

355 patients were included: 177 received plastic stents and 178 received biodegradable stents. PEP occurred in 6.2% (11/177) and 7.3% (13/178), respectively. After IPTW, balance improved for most baseline variables, although procedure year remained imbalanced, reflecting temporal adoption of biodegradable stents. The adjusted PEP risk difference was +3.59% (95%CI -3.27 to +11.37), with no significant difference between groups. Repeat endoscopy within 3 months occurred in 45.2% (80/177) of plastic stent recipients and 0% (0/178) of biodegradable stent recipients (IPTW-adjusted risk difference -51.13%; 95%CI -60.61 to -40.86).

In this largest multicenter retrospective study, biodegradable pancreatic stents were not associated with a significant difference in PEP risk compared with plastic stents after adjustment for confounders. Residual confounding remained possible, particularly due to temporal and procedural factors. Repeat endoscopy for stent removal was eliminated in the biodegradable group. Larger prospective multicenter studies are needed to evaluate the clinical and economic impact.