Fully covered self-expanding metal stents (fcSEMS) and multiple plastic stents (MPS) are now regarded as the first-line therapies for benign biliary strictures (BBS) secondary to chronic pancreatitis (CP). However, with the advancement of lithotripsy and endoscopic retrograde cholangiopancreatography (ERCP) techniques, there has been a significant improvement in successful pancreatic duct decompression rate. In this case, the efficacy of single plastic stent (SPS) warrants reevaluation.

 This is an observational study with 14-year follow-up based on a large prospective CP cohort. Patients treated with endoscopic biliary stenting for BBS secondary to CP from January 2011 to December 2021 were included. The treatment outcomes of SPS, MPS and fcSEMS were compared.

A total of 94 patients were included (SPS=80, fcSEMS=10, MPS=4). Among patients with pancreatic duct stones, 74.3% (52/70) underwent pancreatic lithotripsy, with a successful pancreatic stone clearance rate of 91.4% (64/70). Pancreatic duct patency was achieved in 93.6% (88/94) of all patients. In a comparison between SPS, fcSEMS, and MPS, the ERCP sessions required were 2.0 vs 2.0 vs 1.5 (P = .597). The cumulative BBS recurrence rates were comparable across all groups (P = .889), and the 7-year clinical success rates were 77.5% vs. 60.0% vs. 75.0% (P = .520).

When pancreatic stones are effectively removed and the pancreatic duct is successfully decompressed, SPS, MPS, and fcSEMS demonstrate comparable outcomes in number of ERCP sessions, adverse events, and long-term clinical success for CP related BBS. These findings suggest that SPS should be reconsidered as a viable and cost-effective treatment option.