Biodegradable versus plastic pancreatic stents for preventing post-ERCP pancreatitis: A multicentre propensity...

Biodegradable pancreatic stents are a potential alternative to conventional plastic stents for preventing post-ERCP pancreatitis, but comparative evidence remains limited. This multicentre study compared post-ERCP pancreatitis incidence between biodegradable and plastic pancreatic stents using adjusted analyses to minimise confounding.

This UK multicentre 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 post-ERCP pancreatitis, analysed using IPTW-adjusted risk differences with bootstrap confidence intervals.

A total of 355 patients were included: 177 received plastic stents and 178 biodegradable stents. Post-ERCP pancreatitis 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 post-ERCP pancreatitis risk difference was +3.59% (95% CI -3.27% to +11.37%), with no significant difference between groups. Repeat endoscopy within three 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 multicentre retrospective study, biodegradable pancreatic stents were not associated with a significant difference in post-ERCP pancreatitis 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 multicentre studies are needed to evaluate their clinical and economic impact.