169 Common Bile Duct Stone Management at a District General Hospital: A Baseline Assessment for Biodegradable Biliary Stent Implementation

Abstract Aim To review current management of patients with common bile duct (CBD) stones who are awaiting cholecystectomy. To assess if biodegradable stents would be a viable alternative to plastic. Method Retrospective data from operating theatre software was obtained for patients undergoing cholecystectomy (1/1/22-31/12/22). This was cross referenced with endoscopy reporting software to see if they had undergone ERCP before their procedure (n=82) Results 58 patients (70%) had a plastic stent placed prior to surgery. Their median time to cholecystectomy was 103.5 days (IQR 47.5-232). Their median time to stent removal was 138 days (IQR 71-184.5). 7 patients were waiting more than 1 year for stent removal and one more than 2 years. Pre-cholecystectomy there were 8 admissions with cholecystitis, 3 cholangitis, 2 gall bladder perforations, 1 ERCP pancreatitis and 1 with a blocked CBD stent. Post-cholecystectomy there were 5 patients with blocked/infected stents admitted for an average of 5 days. 1 patient died shortly post-ERCP and stent removal. 24 patients (30%) had ERCP with sphincterotomy only. Their median time to cholecystectomy was 57.5 days (IQR 24-118.5). Only 1 patient required further ERCP before surgery for gallstone pancreatitis. Conclusions It is likely that our hospital is not alone regarding its reliance on two stage ERCP for the management of CBD stones. Biodegradable stents would provide an opportunity to eliminate the risk & cost of a second ERCP; however, a significant improvement in time to cholecystectomy would be required to make it a success. Further information regarding sphincterotomy only management & outcomes is required.