Biodegradable versus plastic stents in the prevention of post-ERCP pancreatitis: a frequency matched cost-effectiveness case-control retrospective study

Aims Prophylactic pancreatic stenting is recommended in case of>1 pancreatic cannulation or opacification during endoscopic retrograde cholangiopancreatography (ERCP). Biodegradable stents can avoid a second procedure to remove the stent, preventing potential complications at a higher cost. The aim is to comparatively analyse the cost-effectiveness of biodegradable technology with focus on safety.

Methods This is a frequency matched cost-effectiveness case-control study. All patients were identified from a database of 174 patients who underwent prophylactic stenting in 2021-2024. Cases were those with a 6-French biodegradable stent. The control group underwent 5-French plastic stenting, randomly selected by 2:1 matching according to Sphincter of Oddi dysfunction and ampullectomy indications. The main endpoints were the post-ERCP pancreatitis (PEP) and reintervention rate. A cost-effectiveness analysis was also performed according to the French Healthcare System.

Results Ninety-three patients (median age: 64, range: 30-92, 45.8% men) were included (32 cases, 64 controls). The most frequent indication was biliary stones (n=29, 30.2%), with no statistically significant differences for benign indication in case-control groups (59.4% vs. 70.3%, p=0.284). The incidence of PEP was comparable (3.1% vs. 3.1%), with no severe PEP. The median length of hospitalization was 2 days (range: 1-33) and the follow-up was 2 months. The reintervention rate was 58.3%, lower in the case group (6.3% vs. 84.4%, p<0.001). The calculated costs of the biodegradable technology were lower (22429€ vs. 90300€, p<0.001)

Conclusions The biodegradable technology allows a much more cost-effective procedure with a comparable PEP rate and less reinterventions.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025