The liver is the primary site of drug metabolism, which can be altered by a variety of diseases affecting the liver parenchyma, especially in patients with liver cirrhosis. The use of antibiotics in patients with cirrhosis is usually a matter of concern for physicians, given the lack of practical knowledge for drug choice and eventual dose adjustments in several clinical scenarios. The aim of the current narrative review is to report, as broadly as possible, basic, and practical knowledge that any physician should have when approaching a patient with liver cirrhosis and an ongoing infection to efficiently choose the best antibiotic therapy.

In the last decade, biodegradable stents have been proposed to spare subsequent endoscopic retrograde cholangiopancreatography (ERCP) procedures required for stent removal [1] [2]. Main adverse events in this field were migration and post-ERCP pancreatitis (PEP) [3] [4]; anecdotally, failure of stent degradation has been reported [5]. We present the case of a 56-year-old man ([Video 1]) who underwent an endoscopic papillectomy (EP) of a 12-mm low-grade adenoma. The patient underwent en bloc EP with a hot snare; both a prophylactic nonsteroidal anti-inflammatory drug suppository and lactated Ringer’s hydration were administered to reduce the risk of PEP. The common bile duct and pancreatic duct (PD) were non-dilatated; both biliary and pancreatic sphincterotomy were performed and an 8.5-Fr biliary plastic stent (Advantix; Boston Scientific, Marlborough, Massachusetts, USA) and a biodegradable pancreatic stent (Archimedes “Fast”) 2 mm in diameter and 6 mm long were placed ([Fig. 1]). The Archimedes Fast degrading pancreatic stent has a declared minimal strength retention of 12 days. The procedure was uneventful and the patient was discharged after two days. Three weeks later, the patient was admitted for mild acute pancreatitis. Computed tomography ([Fig. 2]) showed a 6-mm retained fragment of the pancreatic stent at the level of the neck with mild upstream dilatation of the PD and peripancreatic edema. The patient received hydration and opioids. We observed prompt symptom resolution that allowed a conservative management. A magnetic resonance study one week later showed slow degradation of the retained fragment. We finally removed the biliary stent after three months, withdrawing all medical treatment. Subsequent follow-up was unremarkable. Incomplete biodegradable stent dissolution should be taken into consideration among possible causes of late-onset PEP; however, conservative management could be considered a viable option along with medical and supportive treatment. Endoscopy_UCTN_Code_TTT_1AR_2AI Article published online: 28 January 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany