Natural History and Management Outcomes of Forgotten Biliary Plastic Stents: A Multi-centre Experience

Background Plastic biliary stents are intended for temporary use and should ideally be removed or exchanged within 3–6 months. Prolonged retention, termed "forgotten stents", can lead to significant complications, although a subset of patients remains asymptomatic. This study evaluates the clinical profile, complication rates, and outcomes associated with forgotten plastic biliary stents. Methods We conducted a multicentric retrospective cohort analysis was of 144 patients with plastic biliary stents retained for more than 6 months, presenting to eight tertiary care centres between July 2023 to December 2024. Data included demographics, original stent indications, retention duration, clinical presentation, imaging, interventions, and outcomes. Patients were stratified based on stent duration: 7–12, 13–18, 19–24, and > 24 months. Results The mean age was 41 years; 41.7% male. Average stent duration was 18.3 ± 7.5 months. One-third (33.3%) were asymptomatic; 66.7% presented with biliary symptoms like pain (28.4%) or jaundice (17.4%). Cholangitis occurred in 20.8%, and showed a positive correlation with increasing period of retention. Endoscopic retrieval was successful on first attempt in 84% with 6.9% ultimately requiring surgical intervention. Common reasons for delayed removal were lack of awareness (66.8%) and healthcare access barriers (29.9%). Conclusion Forgotten plastic stents are a source of preventable morbidity. Despite the risk of stentoliths and other complications, more than 90% can be extracted using standard endoscopy techniques. Strategies to reduce the incidence include patient education, structured follow-up with automated reminders, and improved healthcare access.