Biliary stent insertion after stone clearance in patients awaiting cholecystectomy: Systematic review and meta-analysis

Background and study aims Laparoscopic cholecystectomy is the standard treatment for patients with cholecystitis or gallbladder stones after common bile duct (CBD) clearance. According to the sequential strategy, cholecystectomy should be performed within 2 weeks after CDB clearance with endoscopic retrograde cholangiopancreatography (ERCP). However, in real-life experience, the average waiting time is 60 to 180 days. We aimed to evaluate the clinical rationale for prophylactic stent placement in CBD to prevent recurrent biliary events. Patients and methods This systematic review and meta-analysis was performed following a protocol designed a priori (PROSPERO: CRD42024564804; July 13, 2024). All published studies involving patients who had undergone ERCP for CBDs and who were awaiting cholecystectomy were included. Results At the end of the revision process, four full texts including 755 patients were included in the meta-analysis. The odds ratio (OR) for symptom recurrence in patients awaiting cholecystectomy was 0.74 (95% confidence interval [CI] 0.30-1.79; I 2 67%). The pooled OR for adverse event occurrence was 0.74 (95% CI 0.45-1.24) in the stent group. The post-ERCP pancreatitis and cholangitis risk were 0.76 (95% CI 0.25-2.34) and 0.92 (95% CI 0.31-2.67), respectively. Conclusions This meta-analysis showed no benefit for stent insertion after bile duct clearance in patients scheduled for delayed cholecystectomy. Further randomized controlled trials with bigger cohorts are needed to assess any benefit for this procedure, which in the meantime, cannot be recommended.