Endotherapy of postcholecystectomy biliary strictures with multiple plastic stents

Tringali_headshot Post written by Andrea Tringali, MD, PhD, from the Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia, Digestive Endoscopy Unit, and the Università Cattolica del Sacro Cuore, Roma, Italia. Centre for Endoscopic Research Therapeutics and Training—CERTT.

Our study is focused on a large series of patients treated by endoscopic insertion of multiple plastic stents (MPS) to permanently dilate post-cholecystectomy biliary strictures (PCBS). PCBS represents a challenging benign biliary stricture because the main hepatic confluence is frequently involved, especially after the introduction of laparoscopic cholecystectomy. We feel that the long-term results of endoscopic insertion of MPS to treat PCBS are important to provide a durable treatment of a surgery-related adverse event.

154 consecutive patients with PCBS underwent insertion of an increasing plastic stent number, exchanged at regular intervals (3-4 months), until complete morphologic stricture disappearance. Treatment success rate was 96.7% on intention-to-treat analysis. Among 127 patients available for a long-term follow-up (mean 11.2 years), stricture recurrence rate was 9.4% and endoscopic retreatment was possible in all the cases with stricture resolution in 10/12 cases after a further mean follow-up of 9 years. Our results are possibly related to an “aggressive” treatment with a mean maximum number of 4.2 plastic stents. The main limitation of MPS is the need for repeated ERCPs over a 1-year period.

Fully covered self-expandable metal stents (FC-SEMS) can be an alternative to reduce the number of ERCPs and treatment duration but cannot be applied to PCBS close to the main hepatic confluence. Furthermore, results on the use of FC-SEMS for PCBS are limited to a small number of patients with less than 2 years follow-up. Future RCTs comparing MPS with FC-SEMS to treat PCBS are expected in the near future.

Tringali
Figure 2. Cholangiogram showing a Bismuth-Majno type IV postcholecystectomy stricture involving the main hepatic confluence (A), insertion of six 10F plastic stents (B), and stricture resolution after plastic stent removal (C).

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

 

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