Intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend biliary stents: A retrospective cohort study.

BACKGROUND

Biliary stent placement and removal are common medical procedures, but they carry risks of chyme regurgitation and residual common bile duct stones (CBDS), highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.

AIM: To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS, and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.

METHODS

We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024. Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group (DBBSG). Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.

RESULTS

The median age of the patients included was 62 years (interquartile range: 51-70), with 53.11% being female. During stent removal, DBBSG showed higher rates of chyme reflux (23.27% vs 9.65%, P < 0.001) and CBDS (42.77% vs 21.05%, P < 0.001) compared to the single pigtail biliary stent group. No significant differences were found in the incidence of adverse reactions between the two groups (P > 0.05), and no serious events or deaths occurred. DBBSG patients had increased risks of chyme reflux (hazard ratio = 2.793; 95% confidence interval: 1.695-4.603; P < 0.001) and CBDS (hazard ratio: 2.475; 95% confidence interval: 1.732-3.536; P < 0.001).

CONCLUSION

Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS. The safety of intra-biliary cleaning during stent removal has been validated, and as a result, it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.