Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction of uncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. No standardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliary stents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stent extraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) for PCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existing UCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to each case, with detailed emphasis on the technical aspects of the procedure.

Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction of uncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. No standardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliary stents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stent extraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) for PCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existing UCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to each case, with detailed emphasis on the technical aspects of the procedure.

Background: Approximately 20% of patients with gallbladder stones (GS) also have common bile duct stones. This subgroup is susceptible to biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. Risk factors for these complications include older age, the presence of comorbidities, and the existence of multiple GS. This study was conducted to investigate whether the size of GS represents a risk factor for biliary complications. Methods: This retrospective cohort study compared two age- and sex-matched groups. The study group comprised patients who underwent endoscopic retrograde cholangiopancreatography for biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. The control group consisted of patients with GS who presented with non-specific symptoms and did not develop further biliary complications during long-term follow-up. Results: The study group (n = 57) exhibited smaller GS (3.93 ± 3.14 mm vs. 5.45 ± 3.64 mm, P < 0.01), a greater number of GS (8.30 ± 6.24 vs. 6.42 ± 5.63, P < 0.01), and a higher rate of gallbladder sludge (29.8% vs. 15.0%, P = 0.054) compared to the control group (n = 60). The three study subgroups—obstructive jaundice, acute ascending cholangitis, and acute pancreatitis—also displayed significantly smaller GS than the control group (4.6 ± 3.4 mm, 3.2 ± 2.9 mm, and 2.7 ± 1.1 mm vs. 5.45 ± 3.64 mm; P < 0.01, P < 0.006, and P < 0.036, respectively). Additionally, the obstructive jaundice and acute pancreatitis subgroups exhibited a higher number of GS compared to the control group (7.2 ± 6.8 and 7.4 ± 1.1 vs. 6.42 ± 5.63; P < 0.001 and P = 0.038, respectively). Conclusion Patients with biliary complications displayed smaller and more numerous GS compared to those without such complications. Given the uncertainty surrounding the referral of patients with non-specific symptoms for cholecystectomy, incorporating the size and number of GS into the decision-making process may be worthwhile. Further prospective studies are warranted in this area.

Background: Approximately 20% of patients with gallbladder stones (GS) also have common bile duct stones. This subgroup is susceptible to biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. Risk factors for these complications include older age, the presence of comorbidities, and the existence of multiple GS. This study was conducted to investigate whether the size of GS represents a risk factor for biliary complications. Methods: This retrospective cohort study compared two age- and sex-matched groups. The study group comprised patients who underwent endoscopic retrograde cholangiopancreatography for biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. The control group consisted of patients with GS who presented with non-specific symptoms and did not develop further biliary complications during long-term follow-up. Results: The study group (n = 57) exhibited smaller GS (3.93 ± 3.14 mm vs. 5.45 ± 3.64 mm, P < 0.01), a greater number of GS (8.30 ± 6.24 vs. 6.42 ± 5.63, P < 0.01), and a higher rate of gallbladder sludge (29.8% vs. 15.0%, P = 0.054) compared to the control group (n = 60). The three study subgroups—obstructive jaundice, acute ascending cholangitis, and acute pancreatitis—also displayed significantly smaller GS than the control group (4.6 ± 3.4 mm, 3.2 ± 2.9 mm, and 2.7 ± 1.1 mm vs. 5.45 ± 3.64 mm; P < 0.01, P < 0.006, and P < 0.036, respectively). Additionally, the obstructive jaundice and acute pancreatitis subgroups exhibited a higher number of GS compared to the control group (7.2 ± 6.8 and 7.4 ± 1.1 vs. 6.42 ± 5.63; P < 0.001 and P = 0.038, respectively). Conclusion Patients with biliary complications displayed smaller and more numerous GS compared to those without such complications. Given the uncertainty surrounding the referral of patients with non-specific symptoms for cholecystectomy, incorporating the size and number of GS into the decision-making process may be worthwhile. Further prospective studies are warranted in this area.

Background: Approximately 20% of patients with gallbladder stones (GS) also have common bile duct stones. This subgroup is susceptible to biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. Risk factors for these complications include older age, the presence of comorbidities, and the existence of multiple GS. This study was conducted to investigate whether the size of GS represents a risk factor for biliary complications. Methods: This retrospective cohort study compared two age- and sex-matched groups. The study group comprised patients who underwent endoscopic retrograde cholangiopancreatography for biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. The control group consisted of patients with GS who presented with non-specific symptoms and did not develop further biliary complications during long-term follow-up. Results: The study group (n = 57) exhibited smaller GS (3.93 ± 3.14 mm vs. 5.45 ± 3.64 mm, P < 0.01), a greater number of GS (8.30 ± 6.24 vs. 6.42 ± 5.63, P < 0.01), and a higher rate of gallbladder sludge (29.8% vs. 15.0%, P = 0.054) compared to the control group (n = 60). The three study subgroups—obstructive jaundice, acute ascending cholangitis, and acute pancreatitis—also displayed significantly smaller GS than the control group (4.6 ± 3.4 mm, 3.2 ± 2.9 mm, and 2.7 ± 1.1 mm vs. 5.45 ± 3.64 mm; P < 0.01, P < 0.006, and P < 0.036, respectively). Additionally, the obstructive jaundice and acute pancreatitis subgroups exhibited a higher number of GS compared to the control group (7.2 ± 6.8 and 7.4 ± 1.1 vs. 6.42 ± 5.63; P < 0.001 and P = 0.038, respectively). Conclusion Patients with biliary complications displayed smaller and more numerous GS compared to those without such complications. Given the uncertainty surrounding the referral of patients with non-specific symptoms for cholecystectomy, incorporating the size and number of GS into the decision-making process may be worthwhile. Further prospective studies are warranted in this area.