Biodegradable Stents in Benign Biliary and Pancreatic Disease: A Systematic Review

Abstract

Background

Benign biliary and pancreatic diseases, including postoperative strictures, bile leaks, and chronic pancreatitis, often require temporary ductal decompression with plastic or metal stents, which may necessitate repeat interventions due to occlusion, migration, or removal. Biodegradable stents (BDSs) have emerged as an alternative, providing temporary support with spontaneous degradation and avoiding retrieval.

Methods

A systematic search of PubMed, EMBASE, MEDLINE, Scopus, and the Cochrane Library was conducted to May 22, 2025, in accordance with PRISMA guidelines. Eligible studies reported human data on BDS use for benign biliary or pancreatic disease. Outcomes included technical and clinical success, dwell time, complications, and reintervention.

Results

Fifteen studies (467 patients) were included. The most frequent indication was benign biliary stricture, followed by post-cholecystectomy bile leaks and pancreatic duct strictures. Stents were placed via ERCP (n = 193) or percutaneous transhepatic cholangiography (n = 274). Polydioxanone-based devices were most common, with diameters 2-12 mm and lengths 30-125 mm. Technical success was 99.4% and clinical success 73.3%. Across studies, 108 complications were reported, most often cholangitis (n = 36), stricture recurrence (n = 19), haemobilia/bleeding (n = 16), and pain/fever (n = 11); migration and pancreatitis were less frequent. The mean reintervention rate was 35.5% (range 0-100%), largely reflecting planned management after stent degradation rather than device failure. Mean follow-up was 14.4 months (range 0.5-52).

Conclusions

BDSs appear safe and effective in selected benign biliary and pancreatic conditions. Further prospective studies and randomized trials are needed to establish optimal indications and long-term outcomes.