Plastic biliary stents (PS) have been a cornerstone in the endoscopic management of pancreatobiliary diseases in a long time. Nowadays while metal stents (SEMS) have seen significant innovation, is single-use plastic stents remain essential in both benign and malignant biliary obstructions, as well as for bridging strategies and prophylactic applications?
Why single-use plastic stents still matter
Single-use plastic stents are cost-effective, widely available, and offer reliable performance in a variety of clinical scenarios. With increasing concerns about reprocessing efficacy, sterility, and cross-contamination risks, single-use designs provide enhanced safety and workflow efficiency-especially in high-volume centers.
They are preferred in the following situations:
Temporary biliary drainage
Benign biliary strictures
Prophylactic pancreatic duct stenting after ERCP
Post-surgical bile leaks
Bridging before surgery or long-term SEMS placement
Design diversity and customization
Modern PS are available in diameters from 5 Fr to 12 Fr and lengths from 1 cm to 18 cm, with some manufacturers offering custom specifications. The ideal length ensures:
Proximal extension 1–2 cm beyond the stricture
Distal extension 1 cm into the duodenal lumen
Stent designs vary significantly:
Straight or curved bodies
Single or double pigtails (offering superior anchoring in the bile duct or gallbladder)
Tannenbaum-type stents without side holes but multiple flaps to resist migration
Some designs include radiopaque markers, facilitating fluoroscopic placement, and hydrophilic coatings to ease deployment through tight strictures.
Side holes or no side holes?
Side holes, typically located near curled ends, provide an alternate drainage path if the tip becomes occluded. However, their role remains controversial, with concerns about sludge formation and early occlusion. Alternative stent types, such as the Tannenbaum, omit side holes to minimize this risk while improving positional stability.
Clinical iizovations and practical use
Innovative designs such as tapered pigtail stents assist in navigating tight hilar or cystic duct strictures. Dual-guidewire-compatible delivery systems have improved deployment success rates. Additionally, preloaded stent kits reduce procedural time and contamination risk.
In gallbladder drainage (via cystic duct or EUS-guided routes), double-pigtail PS remains the go-to for many endoscopists due to their anchoring capabilities and ease of removal.
When plastic still beats metal?
Despite the advancements in SEMS, plastic stents retain clinical superiority in several settings:
Easily removed or exchanged
Lower upfront cost
Reduced risk of post-ERCP pancreatitis in small-diameter PS
Ideal for short-term interventions or staged procedures
As we continue to innovate in therapeutic endoscopy, single-use plastic biliary stents maintain a critical role in patient-centered care. Their design versatility, safety profile, and affordability make them a mainstay across ERCP and EUS-guided interventions.
With ongoing refinements in materials, delivery systems, and anti-migration features, plastic stents are not just a fallback-they're a strategic choice in modern biliary management.
