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Clinical outcomes and repeat ERCP rates following plastic and metal stent placement in distal biliary strictures: a
1Department of Gastroenterology, Inonu University Faculty of Medicine, Malatya, Turkey. yahyaatayan@hotmail.com.
Background:
Distal biliary strictures may lead to biliary obstruction and serious clinical complications. Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is commonly used for biliary drainage; however, the comparative effectiveness of different stent types remains uncertain. This study aimed to compare clinical outcomes and repeat ERCP requirements among patients receiving 7 Fr plastic stents (PS), 10 Fr PS, or fully covered self-expandable metal stents (FCSEMS) during index ERCP for distal biliary strictures.
Methods:
This retrospective observational cohort study included 100 adult patients who underwent ERCP for distal biliary strictures between 2015 and 2025. Patients were categorized according to the stent type placed during the initial ERCP: 7 Fr PS (n=45), 10 Fr PS (n=35), and FCSEMS (n=20). Biochemical parameters were evaluated before ERCP, on post-procedural day 3, and at week 3. Post-ERCP pancreatitis (PEP), bleeding, cholangitis, and repeat ERCP requirement within 3 months were assessed. Appropriate parametric and non-parametric statistical analyses were performed.
Results:
In the 7 Fr group, the reduction in total bilirubin levels on day 3 did not reach statistical significance (p=0.07), although significant improvements were observed in other biochemical parameters. By week 3, all groups demonstrated significant biochemical improvement (p≤0.003). Within 3 months, repeat ERCP was required in 60% of patients in the 7 Fr group, 30% in the 10 Fr group, and 10% in the FCSEMS group. Overall reintervention rates differed significantly among groups (p=0.001). Lower repeat ERCP rates were observed in patients treated with FCSEMS and larger-diameter plastic stents.
Conclusions:
This study suggests that stent type may be associated with short-term biochemical improvement and repeat ERCP rates in patients with distal biliary strictures. Lower reintervention rates were observed with larger-diameter stents, particularly FCSEMS. However, due to the retrospective design, non-randomized stent selection, and potential baseline imbalances between groups, these findings should be interpreted cautiously. Prospective randomized studies with longer follow-up are needed to further clarify optimal stent selection strategies.
