Role of Endoscopic Biliary Stenting in the Management of Difficult Common Bile Duct Stones

Abstract

Background: Difficult common bile duct (CBD) stones that cannot be removed by standard endoscopic methods remain a problem in resource‑limited centres. Plastic biliary stenting is a low‑cost alternative, but local evidence is limited. Methods: This prospective observational study enrolled 35 adults with difficult CBD stones at a Bangladeshi tertiary hospital (November 2019–March 2021). After sphincterotomy, a 7–10 Fr, 7–12 cm plastic stent was placed across the papilla for three months. Stone size, number, composite index and CBD diameter were recorded at baseline and repeat ERCP. Paired t‑tests assessed change; p < 0.05 was significant. Results: Thirty‑three patients completed follow‑up (mean age 47.7 years; 60 % female). Mean stone diameter fell from 19.1 mm to 15.8 mm, stone count from 1.80 to 1.45, stone index from 28.9 mm to 20.9 mm, and CBD diameter from 17.0 mm to 15.2 mm (all p < 0.001). Stone size decreased in 71 % and index in 87 %. Second‑session ERCP achieved complete clearance in 69.7 %, while 6.1 % cleared spontaneously. Stent‑related cholangitis occurred in 6 %; no deaths were recorded. Conclusion: A three‑month plastic stent significantly reduces stone burden and permits delayed ductal clearance in about three quarters of difficult cases, offering a pragmatic bridge where lithotripsy is unavailable. Multicentre trials comparing stent types and dwell times are warranted, especially in low‑resource settings.