Forgotten Biliary stents – An avoidable complication

Endoscopic Retrograde Cholangio Pancreatography (ERCP) with biliary stenting is one of the most commonly performed endoscopic procedures for preoperative biliary decompression in obstructive jaundice of benign or malignant etiology. In patients with concomitant calculous cholecystitits, a laparoscopic cholecystectomy is performed soon after, and in the absence of a specific indication to the contrary, most such stents are removed 6-8 weeks later. In malignant disease however, the duration of stenting would be dictated by considerations related to the specific treatment modality used. However, some patients are lost to follow up for a stent removal having got almost immediate symptomatic relief from biliary obstruction, blissfully unaware of the complications that may ensue due to an unremoved stent. Retained stents may remain asymptomatic for years, or more commonly, present with blockage and delayed complications requiring another, and often more difficult intervention. Complications related to forgotten biliary endoprosthesis have been documented, some left behind for even as long as 10 years. Prevention is the best option in tackling this situation and detailed instructions to the patient along with thorough documentation of the indwelling stent can go a long way in achieving this. Creating a Stent Registry has also been suggested in this context. The recent invention of the biodegradable biliary stent, one which disintegrates in the biliary tree after a predetermined period and therefore does not require removal, can provide an answer in this scenario. While research has identified Poly-L-Lactic Acid (PLLA) as the material of choice for manufacture of such a stent, use of this device is limited at present with cost and availability being the main hurdles preventing its widespread use. However the way forward undoubtedly lies in its wider use thus preventing a perfectly avoidable complication arising out of a "forgotten stent".