# Impact of bile duct stenting on the management of symptomatic choledocholithiasis: a retrospective multicenter analysis

## TL;DR

This study finds that bile duct stenting in patients with gallstones in the bile duct is linked to more complications, longer hospital stays, and higher costs.

## Contribution

The study provides new evidence on the clinical and economic impacts of bile duct stenting in managing choledocholithiasis.

## Key findings

- Bile duct stenting was associated with significantly higher complication rates (52.4%) compared to no stenting (26.5%).
- Patients with stenting had a longer median hospital stay (19 days) compared to those without stenting (11 days).
- Reimbursements were higher for patients with stenting and for those with complicated courses, regardless of stent use.

## Abstract

Choledocholithiasis (CDL) can lead to various complications and requires treatment approaches for both biliary tract clearing and cholecystectomy. This study aims to characterize CDL patients, evaluate treatment strategies, assess associated complications, and explore economic impacts.

We conducted a retrospective analysis of 112 patients between 2016 and 2021 at two centers. We performed a descriptive analysis comparing outcomes of patients undergoing ERCP with and without bile duct stenting. Univariate and multivariable analyses were used to identify factors related to complications.

Bile duct stenting was associated with significantly higher complication rates (52.4%) compared to the group without stenting (26.5%) (p = 0.006). Factors influencing stent implantation included prior abdominal surgeries (OR = 03.51, p = 0.02), cholangitis at admission (OR = 03.02, p = 0.032), and bile duct diameter (OR = 01.16, p = 0.057). The overall median length of stay was longer for patients with stenting (19 days) compared to those without (11 days) (p < 0.001). Finally, reimbursements were higher for patients with stenting. Reimbursement for complicated courses was higher than for those without, independent of initial bile duct stenting (with stent p = 0.006, without stent p = 0,003).

Bile duct stenting during CDL management is associated with higher complication rates, longer hospital stay, and increased costs. These associations may reflect both clinical severity at baseline and procedural sequencing. A more restrictive placement of biliary stents might be advisable.