Effectiveness of Plastic Stent for the Treatment of Incomplete Clearance of Common Bile Duct Stone: A Systematic Review and Meta-analysis

Background and aims: Common bile duct stones (CBDs) can typically be treated by endoscopic retrograde cholangiopancreatography (ERCP) in 85-90% of cases. However, in the remaining 10-15% of patients, bile duct stones cannot be extracted. In such cases, the placement of a temporary biliary plastic stent is recommended. Methods: We conducted a systematic review and meta-analysis (PROSPERO registration number: CRD42023459712; October 2023). An electronic search was carried out using the following databases: PubMed/MEDLINE, Scopus, and CENTRAL (last search: October 20, 2023). All published studies (both randomized clinical trials and non-randomized interventional studies) involving patients who had undergone ERCP for CBDs with incomplete biliary clearance were included. The risk of bias was assessed using the RoB 2.0 and ROBINS-I tools. The confidence in network meta-analysis tool was employed to estimate each study's contribution matrix within the network estimate. Results: Twenty papers (comprising 902 patients) were selected for qualitative and quantitative synthesis and were included in the standard meta-analysis, while only five studies (254 patients) were used for the network meta-analysis. The pooled success rate of stenting intervention in difficult choledocholithiasis was 79% (95% CI:71-87%). In the network meta-analysis model, ursodeoxycholic acid and single or double stenting resulted in a higher probability of being the most effective treatments. Conclusions: In cases of incomplete CBD clearance, the insertion of a temporary plastic stent achieves complete clearance in 79% of patients. Although not significantly superior in indirect comparison with stent alone, the adjunctive treatment with ursodeoxycholic acid appears to be the most likely to succeed.