Outcomes of Prolonged Biliary Plastic Stent Dwell Time in Patients with Choledocholithiasis Undergoing ERCP Followed by Cholecystectomy

<b>Introduction:</b> ERCP with temporary biliary stenting followed by elective cholecystectomy and postoperative ERCP is commonly used to treat choledocholithiasis. While early stent removal (within 3-6 months) is generally recommended, some studies suggest that longer dwell time may not increase morbidity. This study aims to evaluate outcomes associated with prolonged stent dwell time of more than six months. <b>Methods:</b> We conducted a retrospective study of all patients who underwent ERCP with plastic biliary stent insertion, followed by elective cholecystectomy and postoperative ERCP at a single tertiary center between 2018-2024. Patients were divided into early-ERCP (≤6 months) and late-ERCP (>6 months) groups. The primary outcome was the rate of recurrent biliary episodes. Secondary outcomes included urgent postoperative ERCP, stent reinsertion, and the need for additional ERCP's. <b>Results:</b> A total of 203 patients were included (mean age 58.3 ± 19.8 years). Thirty-one patients (15%) had a stent dwell time of more than six months. Demographic and presenting characteristics were comparable between groups, except for acute cholecystitis, which was more frequent in the early-ERCP group (18% vs. 3.2%, <i>p</i> = 0.034). Recurrent biliary episodes were significantly more frequent in the late-ERCP group (19.4% vs. 5.8%, <i>p</i> = 0.021), as were urgent postoperative ERCP (16.1% vs. 5.2%, <i>p</i> = 0.044), stent reinsertion (35.5% vs. 14.5%, <i>p</i> = 0.008), and additional ERCPs (38.7% vs. 15.7%, <i>p</i> = 0.006). <b>Conclusions:</b> Prolonged biliary stent dwell time beyond six months is associated with significantly higher rates of recurrent biliary episodes, urgent postoperative ERCP, postoperative stent reinsertion, and additional ERCP's.