Comparing Biliary Stenting Alone vs Biliary Stenting with Ursodeoxycholic Acid and Terpene Treatment on Retained Common Bile Duct Stones: A Meta-analysis

Erika Johanna P. Tanada, MD; Salahuddin C. Andam, MD; Maria Hossea C. Monfero, MD; Lucienne Diezmos, MD; John Michael Joseph M. Napa, MD; Rommel P. Romano, MD; Alvin Brian C. Velasco, MD; Stephen N. Wong, MD; Frederick T. Dy, MD; Albert E. Ismael, MD
University of Santo Tomas Hospital

Significance: Large choledocholithiasis is associated with higher rates of failed extraction with conventional endoscopic techniques and pose significant risks. Biliary stenting may serve as a temporary measure, with the goal of facilitating a reduction in the size of the stone, potentially making it amenable to subsequent ERCP and successful extraction. However Biliary stenting alone , may not always achieve complete stone removal on retained stones and addition of choleretic agents such as ursodeoxycholic acid (UDCA) and terpene preparations may promote CBD stone size reduction that could enhance stone clearance. Limited evidence comparing the efficacy of biliary stenting alone versus stenting combined with UDCA and terpene treatment highlights the need for further investigation into their comparative outcomes.

Methodology: Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of biliary stenting alone versus biliary stenting combined with UDCA and terpene treatment published from 2011 to 2024 in PubMed, Elsevier Science Direct, and Google Scholar. The primary outcomes were stone clearance from the CBD, . The secondary outcome includes recurrence rates and adverse events. The study adhered to the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: Six RCTs with 374 participants were included. The that biliary stenting combined with UDCA and terpene treatment had a higher stone clearance rate (88.9%) compared to biliary stenting alone (78.7%). Although recurrence rates were slightly lower in the combination group (9.8% vs. 10.7%), the group was associated with more adverse events (41.3%) compared to stenting alone (16.3%).

Conclusion: The study concludes that combining biliary stenting with UDCA and terpene treatment yields better stone clearance and slightly reduced recurrence rates, but the higher incidence of adverse events necessitates further study.

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