Post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains the most common ERCP-related adverse event, with an incidence of 3.5–9.7%¹. Multiple pre-, peri- and post-procedural strategies have been recommended to reduce this risk¹. A core component of peri-procedural prophylaxis is the placement of a temporary pancreatic duct stent,  if the pancreatic duct was accessed inadvertently¹. Traditionally, short-term plastic pancreatic stents are used which require follow-up abdominal radiography and endoscopic removal if retained. In recent years, biodegradable pancreatic stents have been introduced in clinical practice, offering the advantage of a “deploy-and-forget” approach. This study aims to 1) compare clinical outcomes between plastic and biodegradable pancreatic stents and 2)  identify extra costs related to plastic stents. 

A retrospective review of the ERCP database of the Translational Gastroenterology and Liver Unit, Oxford University Hospitals, was conducted over a 5-year and 9-month period (January 2020–September 2025). In September 2023 the biodegradable pancreatic stents were introduced to our unit.  All ERCP procedures involving placement of pancreatic stents (plastic or biodegradable) were included.  Demographic data, procedural indication (benign vs. malignant), and post-procedural adverse events [PEP, post-ERCP cholangitis (PEC), bleeding, perforation, and 30-day mortality] were recorded. Fisher’s exact test was used to compare categorical outcomes between stent types, while univariate and multivariate logistic regression models assessed predictors of outcomes, supplemented by subgroup analyses stratified by indication (benign vs malignant). Statistical significance was defined as p < 0.05. 

During the study period, 2,995 ERCP procedures were performed, of which 142 (4.74%) had pancreatic stent placement. The median age of patients with pancreatic stent was 71 years. Pancreatic stent cases included 88 (61.97%) females and 54 (38.03%) males.  Plastic stents were placed in 73 (51.41%) and biodegradable stents in 69 patients (48.59%).

When outcomes were compared solely by stent type, plastic stents were associated with slightly higher rates of 30-day mortality (5.48% vs. 1.45%) and perforation (5.48% vs. 1.45%) compared with biodegradable stents, while the incidence of PEP was comparable (plastic: 6.85% vs. biodegradable: 5.80%). There was a trend that plastic stents showed slightly higher rates of PEP [Odds Ratio, OR ≈ 1.13, (95% Confidence Interval- CI 0.29 to 4.37; p= 0.86)] and 30-day mortality [OR ≈ 1.94, (95% CI 0.29 to 12.85; p= 0.49)]. However, these differences were not statistically significant (p > 0.05 for all outcomes).

Multivariable analysis incorporating age (>50 vs. ≤50 years), gender, stent type, and indication was performed, and demonstrated that malignant indication was the only independent predictor of 30-day mortality (OR ≈ 21.8, p = 0.0088). Stent type, age, and gender were not significantly associated with the outcomes. No significant differences were observed for perforation or PEP (all p > 0.05). Due to limited event numbers, PEC and bleeding were excluded from multivariable modelling.

Among the 73 patients who received a plastic pancreatic stent, 16 (22%) required an additional endoscopic procedure for removal of a retained stent, confirmed on follow-up abdominal X-ray.

Pancreatic stent type, irrespective of procedural indication, showed similar results of PEP, 30-day mortalityandperforation compared to plastic stents. However, a substantial proportion of patients with plastic stents (22% in our cohort) required subsequent endoscopic retrieval, thereby increasing healthcare costs and exposing patients to additional ionising radiation (abdominal X-ray to confirm the presence of the retained stent) as well as endoscopic procedure-related risks. In addition, in an era with high pressure on the NHS and other health services and where ‘Greener Endoscopy’ is increasingly recommended and welcomed, the biodegradable stent findings support potential clinical, operational, and environmental advantages.