Complications of Forgotten or Neglected Biliary Plastic Stents and Their Outcome

Abstract

Introduction: Before cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) with common bile duct (CBD) stent placement is the standard therapy for choledocholithiasis. Prolonged stents in situ may present with various complications, some of which may be life-threatening. Methodology: A study in a tertiary center in South India from January 2018 to July 2023. A total of 624 patients underwent ERCP for biliary stent procedures, out of which 29 had biliary plastic stents in situ for more than 6 months. We retrospectively analyzed these 29 cases for complications and their treatment outcomes. Results: The mean ± standard deviation age was 57.5 ± 16.6 years, male-to-female ratio was 2.2:1, 55.17% had a cholecystectomy (n = 16), the most common indications for CBD stent placement were choledocholithiasis 75.8% (n = 22); the median duration of stent in situ was 7 months interquartile range (6–9). The reasons for delayed CBD stent removal were: 27.6% due to the COVID-19 pandemic (n = 8), 13.8% surgically unfit (n = 4), 6.9% financial constraints (n = 2), 3.4% of patients were unaware of the stent in situ (n = 1), and 48.3% were unknown (n = 14). The complications associated were that 69% had calculi/sludge (n = 20), 24.14% had cholangitis (n = 7), 7% were asymptomatic (n = 2), and 3% had intestinal perforation (n = 1). Conclusion: Early complication identification and treatment lead to successful clinical outcomes. Irrespective of cholecystectomy, a check cholangiogram, and CBD clearance should be done in all cases of biliary stent removal.