Intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend biliary stents: A retrospective cohort study

doi:10.4240/wjgs.v17.i11.110036

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Nov 27, 2025 (publication date) through Nov 25, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Surg. Nov 27, 2025; 17(11): 110036
Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.110036

Intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend biliary stents: A retrospective cohort study

Hong-Lei Zhang, Cheng Zhang, Chen Qiu, Bo-Sen Zhang, An-Hua Huang, Jian-She Yang, Zhao-Yan Jiang, Liang Zheng, Hai Hu, Yu-Long Yang

Hong-Lei Zhang, Cheng Zhang, Chen Qiu, Bo-Sen Zhang, An-Hua Huang, Zhao-Yan Jiang, Liang Zheng, Hai Hu, Yu-Long Yang, Center for Gallbladder Diseases, Shanghai East Hospital Affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine, Shanghai 200120, China

Jian-She Yang, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200092, China

Co-corresponding authors: Hai Hu and Yu-Long Yang.

Author contributions: Zhang HL wrote the first draft of the manuscript; Zhang HL and Zhang C performed conceptualization and methodology, wrote the manuscript, and reviewed the literature; Qiu C and Zhang BS collected the data and performed the experiments; Yang JS and Zheng L conducted data organization and analysis; Huang AH, Yang JS, and Jiang ZY carried out the technical editing of integrating pictures, making tables and critically reviewing the research plan and manuscript; Yang YL and Hu H were responsible for the concepts, methods, research guidance, and paper revision; Zhang HL, Zhang C, Qiu C, Zhang BS, Huang AH, Yang JS, Jiang ZY, Zheng L, Hu H, and Yang YL contributed to the study conception and design, and commented on previous versions of the manuscript; and all authors read and approved the final manuscript.

Supported by the Key Specialty Construction Project of Shanghai Pudong New Area Health Commission, No. PWZzk2022-17; the Featured Clinical Discipline Project of Shanghai Pudong, No. PWYts2021-06; Clinical Research Project of Shanghai East Hospital, No. DFLC2022019; and Shanghai Dongfang Hospital Key Discipline Department of Gallstone Disease, No. 2024-DFZD-005DS.

Institutional review board statement: This study was approved by the Medical Ethics Committee of East Hospital Affiliated to Tongji University, approval No.[2022] Research Review (107).

Informed consent statement: Signed informed consent was obtained from all participants prior to the study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yu-Long Yang, MD, PhD, Academic Fellow, Chief Physician, Full Professor, Center for Gallbladder Diseases, Shanghai East Hospital Affiliated with Tongji University and Institute of Gallbladder Diseases of Tongji University School of Medicine, No. 150 Jimo Road, Shanghai 200120, China. yyl516@tongji.edu.cn

Received: May 28, 2025
Revised: July 21, 2025
Accepted: September 9, 2025
Published online: November 27, 2025
Processing time: 181 Days and 1.5 Hours

Abstract

BACKGROUND

Biliary stent placement and removal are common medical procedures, but they carry risks of chyme regurgitation and residual common bile duct stones (CBDS), highlighting the necessity of intra-biliary cleansing during secondary endoscopic stent removal.

AIM

To compare the incidence of chyme reflux into the common bile duct and residual or recurrent CBDS, and the safety of intra-biliary cleansing during secondary duodenoscopic removal of duodenal bend vs single pigtail biliary stents.

METHODS

We included 554 patients undergoing secondary duodenoscopy for biliary stent removal and intra-biliary cleansing from March 2019 to September 2024. Patients were divided into a single pigtail biliary stent group and a duodenal bend biliary stent group (DBBSG). Chyme reflux and CBDS occurrences were compared using the Cox proportional hazards model.

RESULTS

The median age of the patients included was 62 years (interquartile range: 51-70), with 53.11% being female. During stent removal, DBBSG showed higher rates of chyme reflux (23.27% vs 9.65%, P < 0.001) and CBDS (42.77% vs 21.05%, P < 0.001) compared to the single pigtail biliary stent group. No significant differences were found in the incidence of adverse reactions between the two groups (P > 0.05), and no serious events or deaths occurred. DBBSG patients had increased risks of chyme reflux (hazard ratio = 2.793; 95% confidence interval: 1.695-4.603; P < 0.001) and CBDS (hazard ratio: 2.475; 95% confidence interval: 1.732-3.536; P < 0.001).

CONCLUSION

Duodenal bend biliary stents increase the risk of chyme reflux into the common bile duct and CBDS. The safety of intra-biliary cleaning during stent removal has been validated, and as a result, it is recommended that endoscopists perform intra-biliary cleaning during duodenoscopic removal of duodenal bend biliary stents.

Keywords: Biliary stent; Intra-biliary cleansing; Enterobiliary reflux; Common bile duct stones; Endoscopic retrograde cholangiopancreatography; Adverse reactions after endoscopic retrograde cholangiopancreatography

Core Tip: In clinical practice, compared to single-pigtail biliary stents, patients with duodenal bend biliary stent have a significantly increased risk of chyme reflux into the bile duct and common bile duct stones (residual or recurrent). Performing intra-biliary cleansing after stent removal can improve patient prognosis. The finding of this study will increase endoscopists’ awareness of the importance of intra-biliary cleansing during biliary stent placement and replacement, thereby optimising clinical practice and improving patient prognosis.