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Is a follow up endoscopic retrograde cholangiography procedure necessary for removal of biliary stent? Shashank Ponugoti Follow up endoscopic retrograde cholangiopancreatography (ERCP) procedure is routinely performed to remove biliary stents. Simply removing the stents is feasible with upper endoscopy (EGD), which costs less, is technically less challenging, is likely to be more comfortable for the patient, and is safer from a sedation perspective. But therapeutic interventions requiring ERCP may preclude this option. The aim of this study was to analyze the utility of follow up ERCP for biliary stent removal and to determine if follow up ERCP procedure is necessary in all patients. The study population comprised 284 adults who had undergone ERCP for stent placement and stent removal at the WVU Endoscopy Center between January 2005 and December 2011. Detailed information on each patient was obtained from medical records. Patients were categorized into five groups those with bile leak alone (N=31), choledocholithiasis (N=127), benign stricture (N=77), malignant stricture (N=44) and bile leak with stone or stricture (N=5). On follow up ERCP, only 16% of patients in the bile leak group required therapy. In contrast, 90% of patients with choledocholithiasis, 82% of patients with benign stricture and 100% of patients in the remaining two groups required therapy that could only be accomplished with follow up ERCP. The two most common employed therapies in follow up ERCPs were stone or sludge removal (57%) and stent replacement (35%). Conclusions: In this retrospective study spanning 7 years, only 16% of patients with uncomplicated bile leak required a follow up ERCP for stent removal, whereas ERCP related interventions were needed at follow-up in 82-100% of patients with other conditions. Larger prospective studies are needed to confirm these findings and to determine if EGD might serve as a viable and cost effective alternative to ERCP in cases of uncomplicated bile leak.