Post-ERCP Prophylactic Biliary Stenting Before Cholecystectomy: A Systematic Review and Meta-Analysis

Placing a plastic stent in the common bile duct is standard practice when a stone cannot be completely retrieved during ERCP, but placing a "prophylactic" stent after complete stone extraction in patients awaiting cholecystectomy is generally not advised. However, anecdotally, this remains common practice. To evaluate this strategy, investigators conducted a systematic review and meta-analysis of 10 studies comprising 1259 patients, including 692 with stents and 567 without, and compared outcomes between patients who received prophylactic biliary stenting versus those who did not.

The meta-analysis found no significant difference in the pooled odds of recurrent choledocholithiasis between the stent and no-stent groups (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.21-1.43). However, as expected, prophylactic stenting was associated with a significantly higher likelihood of requiring a repeat ERCP (OR, 3.13; 95% CI, 1.32-7.42). Furthermore, although the odds of acute cholangitis or post-ERCP pancreatitis did not differ significantly between the groups, the odds of developing acute cholecystitis were significantly higher in the stented cohort (OR, 2.53; 95% CI, 1.01-6.38).