ROLE OF BILIARY STENTING IN THE MANAGEMENT OF LARGE OR MULTIPLE COMMON BILE DUCT STONES

Abstract

Background:

Difficult common bile duct (CBD) stones, characterized by large size (≥15 mm), multiplicity, or impaction, present significant challenges to endoscopic clearance. Advanced lithotripsy techniques are effective but remain costly and limited in availability in resource-constrained settings. Biliary stenting has been proposed as an interim or adjunctive approach to facilitate subsequent clearance.

Objective: This study aimed to evaluate the efficacy and safety of biliary stenting in reducing stone burden and improving clearance rates in patients with large or multiple CBD stones.

Methods:

A prospective observational study was conducted at Faisalabad Teaching Hospital over six months after ethical approval from the institute and department ((Dec to May 2025) (enrolling 60 patients with difficult CBD stones in whom complete clearance was not feasible during the index ERCP. Patients underwent placement of a 7–10 Fr plastic biliary stent, followed by repeat ERCP after three months . Stone characteristics, reduction in stone size and number (stone index), clearance rates, and procedure-related complications were recorded. Statistical analyses included paired t-tests, chi-square tests, and logistic regression.

Results:  The mean age of patients was 48.7 ± 11.9 years, with 53.3% males. Large stones were present in 36 patients (60%), while 24 (40%) had multiple stones. The median largest stone diameter decreased from 17 mm to 9 mm post-stenting (p < 0.001), with a significant reduction in stone number as well (p < 0.001). Definitive clearance without further intervention was achieved in 61.7% of patients, while 38.3% required additional ERCP or surgery. Complication rates were low and not statistically different between groups.

Conclusion:

Biliary stenting is a safe and effective strategy for managing large or multiple CBD stones, significantly reducing stone burden and facilitating subsequent clearance.