One Stent, One Visit: A Five-Year Sustainable Quality Improvement Evaluation of Biodegradable ERCP Stenting at Aberdeen Royal Infirmary

Project completed as part of the 2026 Green Gastroenterology Challenge. 

Team members

Salman Idrees Bhutta, Subita Suparmanian, Akshita Agarwal. 

Setting / patent group: 

Aberdeen Royal Infirmary, NHS Grampian’s tertiary hepato-pancreato-biliary and ERCP centre serving around 626,000 people. The evaluation included 152 patients who received biodegradable stents between October 2020 and October 2025 (78 biliary and 74 pancreatic).                       

Issue:

Conventional plastic biliary and pancreatic stents require follow-up investigations and additional procedures for removal or retrieval. This results in extra hospital attendances, costs, carbon emissions, pressure on endoscopy services and exposure to procedure-related risks.

Intervention: 

Archimedes biodegradable ERCP stents for appropriate benign biliary and pancreatic indications were incrementally increased over a five-year period, to replace standard plastic stents. Biodegradable stents dissolve in situ, removing the need for subsequent stent removal procedures, including ERCP for biliary stents and abdominal x-ray and OGD for pancreatic stents. The project retrospectively evaluated five years of established practice and compared it with a modelled plastic-stent pathway. 

Potential Outcomes:

Clinical: 

Across 152 patients, technical success was 100%. Bile leak resolution was 96.5% (55/57), all other biliary indications showed high success, pancreatic duct disruptions resolved in 100% (2/2), and no stent-related serious adverse events were reported. 

Population:

No negative population outcomes were identified, as the intervention reduced repeat hospital attendances without restricting access to care. This is particularly relevant within NHS Grampian's large geographical catchment and may benefit patients who are older, have multiple co-morbidities, from low-income families, who face challenges attending hospital appointments.

Environmental:

Biodegradable stents avoided 78 repeat ERCPs, 22 retrieval OGDs and 74 abdominal X-rays over five years, resulting in an estimated carbon saving of 5,110.6 kgCO2e. This averages a yearly carbon saving of 1,022.1 kgCO2e.

Financial: 

Avoided procedures were valued at £103,665 and, after accounting for the higher stent acquisition cost, produced a net procedure-cost saving of £11,295 over five years (or £2,259 financial saving annually). 

Social 

The pathway removed 152 return hospital appointments. All patients and staff surveyed supported the approach. Avoided travel and time away from work generated estimated patient savings of £7,190 in travel costs and £14,489 in lost wages over five years. This equated to a £147 per patient saving or a combined yearly saving of £4,336.

Key learning points

Biodegradable stents maintained expected clinical outcomes while reducing environmental impact, releasing hospital capacity and generating modest cost savings. The project also produced a reproducible bottom-up evaluation model that can be adapted by other services.