Introduction Cholecystectomy is recommended in patients with biliary ductal stones after clearing the CBD with ERCP (endoscopic retrograde Cholangiopancreatography) due to increased risk of further recurrent biliary complication if gallbladder left in situ. There are no randomised controlled trials (RCTs) to date on the post ERCP management of biliary ductal stones in patients who are deemed unfit for cholecystectomy. Practice varies amongst ERCPists from routine ERCP with regular stent changes in this group to ERCP only when there is evidence of recurrent biliary complication due to recurrent ductal stones.
Methods Retrospective review of ERCP database between Jan 2010 to Dec 2013 to review whether elective stent changes after CBD stone clearance offer any protection against biliary complications in patients deemed unfit for cholecystectomy.
Inclusion criteria were, index ERCP for confirmed or suspected CBD stones, complete clearance of CBD at ERCP, gall bladder in situ and patient deemed unfit for cholecystectomy.
Exclusion criteria were, gall bladder absent, patient fit for cholecystectomy but declined surgery, stricture seen at ERCP.
Complications were defined as any subsequent unplanned ERCP from their index ERCP which achieved the inclusion criteria.
Results A total of 1628 ERCPs in 1090 patients were reviewed. 356 patients fulfilled the inclusion criteria. 143 patients were in the regular stent change group (RSCG) and 213 patients in the non-stented group (NSG).
The number of complications episodes leading to unplanned urgent or emergency ERCPs in RSCG were 40 (28%) whilst in NSG were 22 (10%). Median time between ERCPs was 7 months for the RSCG whilst it was 9 months for the NSG.
A complete analysis of the data can be seen in the table below.
Conclusion This study shows that patients who were on regular CBD stent change programme had more complications leading to unplanned ERCPs compared with patients who did not have a biliary stent placed. Therefore regular biliary stent changes in this group of patients with clear ducts offer no benefit in reducing complications. A randomised trial is needed to guide on the management of such patients
Disclosure of Interest None Declared