Stent occlusion represents a major cause of recurrent biliary obstruction (RBO) after biliary stent placement. Whether ursodeoxycholic acid (UDCA) can reduce stent occlusion remains uncertain. This study aimed to evaluate the efficacy of UDCA following biliary stenting for RBO.

We performed a retrospective analysis of patients with RBO who underwent ERCP between January 2021 and December 2023 and required at least one reintervention within 36 months after initial stent placement. A total of 531 patients previously treated with either plastic or metallic stents were screened and included in the study cohort.

Of the 492 eligible patients, 348 (70.7%) received UDCA and 144 (29.3%) did not. Overall stent patency was longer in the UDCA group (median 90 days, IQR 60–150) compared with non-UDCA patients (median 90 days, IQR 60–90) (p = 0.03). Cholangitis at re-intervention occurred in 181/348 (52.0%) UDCA users versus 58/144 (40.3%) non-users (p = 0.02). In patients with plastic stents (n = 320), patency was similar between groups (median 90 days, IQR 60–120 for both; p = 0.55), as were cholangitis rates (51.3% vs. 45.6%; p = 0.42). In contrast, among patients with self-expandable metallic stents (SEMS; n = 81), patency was significantly longer with UDCA (median 180 days, IQR 120–180) than without (median 180 days, IQR 60–180) (p = 0.045), while cholangitis rates remained comparable (73.4% vs. 64.7%; p = 0.68). Sphincterotomy, performed in 92.7% (455/492) of cases, showed a non-significant trend toward prolonged patency (median 90 vs. 60 days; p = 0.10).

UDCA improved overall stent patency, particularly in patients with metallic stents, supporting its role as a useful adjunct after ERCP. Although cholangitis rates were unchanged, the patency benefit suggests added value in the management of recurrent biliary obstruction