SP7.12 Is prophylactic biliary stenting necessary in patients who underwent ERCP and duct clearance, prior to cholecystectomy?

Abstract Aims Approximately 15% of patients with gallstones will present with choledocholithiasis and undergo ERCP, prior to cholecystectomy. Some clinicians will leave a plastic stent in a cleared duct to protect the duct from further dropped stones, whilst the patient is waiting for cholecystectomy. It is unclear however, as to whether stenting in this setting prevents biliary complications and there is no consensus in the literature to confirm best practice. Methods This was a retrospective, non-randomised, single centre study looking at 1068 consecutive patients who underwent laparoscopic cholecystectomy between January 2020 and October 2022. We identified patients who had undergone pre-operative ERCP and duct clearance and compared two groups (stent vs no stent) with reference to further admissions to hospital with complications related to CBD stones/ stent, necessitating ERCP. Results Of the 1068 patients who underwent cholecystectomy, 150 patients had a pre-operative ERCP. 7 patients were discarded due to incomplete records. Of the remaining 143, 133 achieved successful duct clearance: n= 97 (73%) were not stented and n=36 (27%) had a prophylactic stent inserted. 18/133 (23%) patients in total required further ERCP prior to cholecystectomy: 10/97 (10%) in the non-stented cohort vs 8/36 (22%) in the stented cohort. Conclusion Our findings suggest that prophylactic biliary stenting is associated with higher rates of repeat ERCP, prior to laparoscopic cholecystectomy and therefore cannot be routinely recommended. This was a retrospective, non-blinded, non-randomised cohort study and therefore we would require a randomised control trial to confirm or refute our findings.