Prevention of Cholangitis by Spontaneously Dislodging Biliary Stent After an Endoscopic Procedure in Patients With Asymptomatic Bile Duct Stones.

Objective: To evaluate the effectiveness of spontaneously dislodging biliary stent (SDBS) placement in preventing acute cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with asymptomatic bile duct stones.

Methods: This retrospective, single-center study included 63 patients (mean age, 73 ± 11 years; 43 men) who underwent ERCP for asymptomatic bile duct stones at our institute between April 2022 and May 2024; they were categorized into the SDBS (33 patients) and non-stent (30 patients) groups. Stone removal was performed in all cases, and complete stone clearance was achieved. Post-procedure cholangitis was diagnosed based on the Tokyo Guidelines 2018. The primary endpoint was post-procedural acute cholangitis on day one. Secondary endpoints included cholangitis-related factors, type of device used, procedure time, and adverse events other than cholangitis. Multivariate analysis was performed to identify factors associated with post-procedure cholangitis.

Results: No significant differences were observed in prior cholecystectomy, bile duct diameter, or the number of stones between the two groups. The overall incidence of post-procedure cholangitis was 17.4%. The incidence was significantly lower in the SDBS group than in the non-stent group (6% vs. 30%; 0.01). No significant differences were observed in procedure time, incidence of complications such as post-ERCP pancreatitis, or postoperative hospital stay between the SDBS and non-stent groups. Multivariate analysis identified the absence of an SDBS (odds ratio, 6.09; 95% confidence interval, 1.04-35.6, 0.04) as an independent factor associated with post-procedure cholangitis.

Conclusion: SDBS placement may be effective in preventing cholangitis after ERCP in asymptomatic patients with bile duct stones.