Biodegradable stents for ERCP: dream or reality?

Biodegradable stents have been a longstanding dream for endoscopy in general, and for endoscopic retrograde cholangiopancreatography (ERCP) in particular. They could be used to treat a variety of benign and malignant conditions and could potentially save patients from repeat procedures that are performed solely for stent removal. In a recent study, researchers prospectively evaluated degradation time, technical features, and safety of novel, helicoidally shaped, biodegradable pancreatic and biliary stents.

The stents, of various sizes, were designed to degrade at different rates: slow (11 weeks), medium (20 days), and fast (12 days). Thirty-eight patients underwent placement of 53 biodegradable stents (34 biliary and 19 pancreatic). Stents were evaluated at different predetermined time points depending on their degradation rate.

At the first time point, across stent types, 48 stents (91%) had partially degraded and 5 stents migrated early. At the second time point, 100% of stents had fully degraded. Fluoroscopic visualisation was subjectively rated as good or excellent for 94% of stents.

At 6-month follow-up, no patients had required readmission or additional treatments for symptom recurrence or adverse events. One patient developed post-ERCP pancreatitis.

In this small but prospective study, biodegradable stents appear to have at least minimally acceptable safety and efficacy. The authors mention the possibility that these devices could have pharmaceutical agents incorporated into them, potentially making them both drug-eluting and biodegradable.