Effect of Prophylactic Biliary Stent After Stone Clearance in Reducing Recurrence of Adverse Events Among Patients Awaiting Cholecystectomy: An Analysis of the United States Readmission Database

Background and Aims In patients awaiting cholecystectomy, the role of endoscopic biliary sphincterotomy (EST) with biliary stenting is controversial. We aimed to assess the impact of biliary stenting in these patients. Methods The Nationwide Readmission Database (2016-2020) was queried to identify adult hospitalizations with cholelithiasis and choledocholithiasis that underwent endoscopic retrograde cholangiopancreatography (ERCP) with EST without biliary stenting (Group 1) and biliary stenting (Group 2). Readmission characteristics, post-ERCP pancreatitis (PEP), mean length of hospital stay (LOS), and mean total hospitalization charge (THC) were analyzed. Results For all biliary events, the risk of 30-day (1.18% vs 0.67%, Adjusted Hazard Ratio (aHR) 1.78, 95% confidence interval [CI] 1.55-2.04, p-value<0.001), 60-day (2.12% vs 1.04%%, aHR 2.04 95% CI 1.82-2.28, P<0.001), and 90-day (2.66% vs 1.27%%, aHR 2.07, 95% CI 1.86-2.30, p<0.001) readmissions was higher in Group 2 compared to Group 1. Similarly, the risk of 30-, 60-, and 90-day readmissions for choledocholithiasis, cholecystitis, cholangitis, and gallstone pancreatitis, and mean LOS and THC was higher in Group 2 compared to Group 1. After adjusting for confounders, Group 2 had higher rates of readmission for PEP within 48 hours from hospital discharge (0.05% vs 0.03%, Adjusted Odds Ratio (aOR) 1.93, 95% CI 1.05-3.52, p=0.032) compared to Group 1, while there was no statistical difference in the rates of PEP between 48 hours to 7 days of hospital discharge between the two groups. Conclusion For biliary events, patients with biliary stenting had higher readmission risk, LOS, THC, and PEP within 48 hours of discharge compared to non-stented patients.