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. 2025 Nov 27;17(11):110036.
doi: 10.4240/wjgs.v17.i11.110036.

Intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend biliary stents: A retrospective cohort study

Hong-Lei Zhang  1 , Cheng Zhang  1 , Chen Qiu  1 , Bo-Sen Zhang  1 , An-Hua Huang  1 , Jian-She Yang  2 , Zhao-Yan Jiang  1 , Liang Zheng  1 , Hai Hu  1 , Yu-Long Yang  3
Affiliations

Intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend biliary stents: A retrospective cohort study

Hong-Lei Zhang et al. World J Gastrointest Surg. .

Abstract

Background: Biliary stent placement and removal are common medical procedures, but they carry risks of chyme regurgitation and residual common bile duct stones (CBDS), highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.

Aim: To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS, and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.

Methods: We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024. Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group (DBBSG). Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.

Results: The median age of the patients included was 62 years (interquartile range: 51-70), with 53.11% being female. During stent removal, DBBSG showed higher rates of chyme reflux (23.27% vs 9.65%, P < 0.001) and CBDS (42.77% vs 21.05%, P < 0.001) compared to the single pigtail biliary stent group. No significant differences were found in the incidence of adverse reactions between the two groups (P > 0.05), and no serious events or deaths occurred. DBBSG patients had increased risks of chyme reflux (hazard ratio = 2.793; 95% confidence interval: 1.695-4.603; P < 0.001) and CBDS (hazard ratio: 2.475; 95% confidence interval: 1.732-3.536; P < 0.001).

Conclusion: Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS. The safety of intra-biliary cleaning during stent removal has been validated, and as a result, it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.

Keywords: Adverse reactions after endoscopic retrograde cholangiopancreatography; Biliary stent; Common bile duct stones; Endoscopic retrograde cholangiopancreatography; Enterobiliary reflux; Intra-biliary cleansing.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow diagram of patient selection. IBS: Integrated bile duct stent; SPBS: Single pigtail biliary stent; SPBSG: Single pigtail biliary stent group; DBBSG: Duodenal bend biliary stent group.
Figure 2
Figure 2
Kaplan-Meier curves for primary outcomes. A: Probability of chyme reflux by types of biliary stent; B: Probability of common bile duct stones by types of biliary stent; C: Probability of chyme reflux by sex; D: Probability of common bile duct stones by sex. HR: Hazard ratio; CI: Confidence interval; BS: Biliary stent; CBDS: Common bile duct stones; SPBS: Single pigtail biliary stent; DBBS: Duodenal bend biliary stent.
Figure 3
Figure 3
Hazard ratios and 95% confidence intervals of chyme reflux into the bile duct and common bile duct stones according to types of biliary stents. A: Hazard ratios and 95% confidence intervals of chyme reflux into the bile duct according to types of biliary stents; B: Hazard ratios and 95% confidence intervals of common bile duct stones according to types of biliary stents. HR: Hazard ratio; CI: Confidence interval; PBM: Pancreaticobiliary maljunction; EST: Endoscopic sphincterotomy; DP: Duodenal papillopathy; SOD: Sphincter of Oddi dysfunction; PDS: Pancreatic duct stent.
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