Jorge Manuel Tavares Canena from the Center of Gastroenterology, Cuf Infanto Santo Hospital, Faculty of Medical Sciences – Nova Medical School and Department of Gastroenterology, Pulido Valente Hospital, Faculty of Medical Sciences – Nova Medical School in Lisbon, Portugal discusses his article “Predictive value of cholangioscopy after endoscopic management of early postcholecystectomy bile duct strictures with an increasing number of plastic stents: a prospective study” from the February issue.
The endoscopic management of postcholecystectomy bile duct strictures (PCBS) by ERCP has been established as an alternative treatment to surgery due to its favorable long-term clinical effectiveness. Several studies have reported conflicting results regarding the predictors of success or failure of endotherapy. However, no study has evaluated the role of cholangioscopic findings in predicting the outcome of treatment after the endoscopic management of bile duct strictures. We conducted a study aiming to evaluate the different cholangioscopic appearances of PCBS after endotherapy and their predictive values for the outcome of the treatment.
Benign strictures in different parts of the digestive tract have different endoscopic appearances, which may be a predictive factor for the treatment outcome. No study has evaluated the role of cholangioscopic findings in predicting the outcome of treatment after the endoscopic management of bile duct strictures. We hypothesized that the cholangioscopic appearance of the PCBS after endoscopic management with an increasing number of plastic stents may play a role in the outcome of the treatment.
Figure 3. Cholangioscopic view of minor narrowing of a bile duct caused by tissue hyperplasia.
After endotherapy of PCBS, 3 different findings were noted on cholangioscopy: 1) no lesion or minor defect; 2) minor stricture with a fibrous ring; 3) presence of tissue hyperplasia. Although all the patients had a well calibrated bile duct at the end of endotherapy only patients with a cholangioscopic pattern of tissue hyperplasia were at risk of stricture relapsing and they should undergo an additional period of endoscopic stenting, perhaps for 3 to 6 months until endoscopic resolution of the tissue hyperplasia. We suggest that a prospective, multicenter study including a large number of patients should be performed to validate our findings in a large population.
Find this article on pages 279-288 of the print journal or read the abstract online.
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