Effectiveness of Plastic Stent for the Treatment of Incomplete Clearance of Common Bile Duct Stone: A Systematic Review and Meta-analysis

Marco Valvano; Antonio Vinci; Filippo Antonini; Amedeo Montale; Annalisa Capannolo; Stefano Fabiani; Gianpiero Stefanelli; Marco Magistroni; Marta Mosca; Susanna Faenza; Fabio Ingravalle; Mariachiara Campanale; Maurici Massimo; Giovanni Latella

doi:10.15403/jgld-5964

Authors

Marco Valvano Gastroenterology Unit, Ente Ospedaliero Galliera. Via delle Mura Cappuccine, Genova; Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi, L’Aquila, Italy
Antonio Vinci Hospital Health Management Area, Local Health Authority „Roma 1”, Roma, Italy
Filippo Antonini Gastroenterology and Interventional Endoscopy Unit, Mazzoni Hospital, Ascoli Piceno, Italy
Amedeo Montale Gastroenterology Unit, Ente Ospedaliero Galliera. Via delle Mura Cappuccine, Genova, Italy
Annalisa Capannolo Diagnostic and Surgical Endoscopy Unit, San Salvatore Academic Hospital, L’Aquila, Italia
Stefano Fabiani Gastroenterology and Digestive Endoscopy Unit, Ospedale Civile Santo Spirito, Pescara, Italy
Gianpiero Stefanelli Gastroenterology Unit, Ente Ospedaliero Galliera. Via delle Mura Cappuccine, Genova, Italy
Marco Magistroni Gastroenterology and Digestive Endoscopy Unit, ASST Santi Paolo e Carlo, Milan, Italy
Marta Mosca Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi, L’Aquila, Italy
Susanna Faenza Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi, L’Aquila, Italy
Fabio Ingravalle Hospital Health Management Area, Local Health Authority „Roma 6”, Albano Laziale, Italy
Mariachiara Campanale Gastroenterology Unit, Ente Ospedaliero Galliera. Via delle Mura Cappuccine, Genova, Italy
Maurici Massimo Department of Biomedicine and Prevention, Tor Vergata University of Rome, Italy
Giovanni Latella Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi, L’Aquila, Italy

DOI:

https://doi.org/10.15403/jgld-5964

Keywords:

endoscopic retrograde cholangiopancreatography, ERCP, common bile duct stones, ursodeoxycholic acid, UDCA, biliary stone, biliary stent

Abstract

Background and Aims: Common bile duct stones (CBDs) can typically be treated by endoscopic retrograde cholangiopancreatography (ERCP) in 85–90% of cases. However, in the remaining 10–15% of patients, bile duct stones cannot be extracted. In such cases, the placement of a temporary biliary plastic stent is recommended.

Methods: We conducted a systematic review and meta-analysis (PROSPERO registration number: CRD42023459712; October 2023). An electronic search was carried out using the following databases: PubMed/MEDLINE, Scopus, and CENTRAL (last search: October 20, 2023). All published studies (both randomized clinical trials and non-randomized interventional studies) involving patients who had undergone ERCP for CBDs with incomplete biliary clearance were included. The risk of bias was assessed using the RoB 2.0 and ROBINS-I tools. The confidence in network meta-analysis tool was employed to estimate each study‘s contribution matrix within the network estimate.

Results: Twenty papers (comprising 902 patients) were selected for qualitative and quantitative synthesis and were included in the standard meta-analysis, while only five studies (254 patients) were used for the network meta-analysis. The pooled success rate of stenting intervention in difficult choledocholithiasis was 79% (95% CI:71-87%). In the network meta-analysis model, ursodeoxycholic acid and single or double stenting resulted in a higher probability of being the most effective treatments.

Conclusions: In cases of incomplete CBD clearance, the insertion of a temporary plastic stent achieves complete clearance in 79% of patients. Although not significantly superior in indirect comparison with stent alone, the adjunctive treatment with ursodeoxycholic acid appears to be the most likely to succeed.