Long-term results of endoscopic drainage of common bile duct strictures in chronic pancreatitis

• Published in: European journal of gastroenterology & hepatology Vol. 17; no. 1; pp. 103 - 108
• Main Authors: Cahen, Djuna L, van Berkel, Anne-Marie M, Oskam, Daphne, Rauws, Erik AJ, Weverling, Gerrit Jan, Huibregtse, Kees, Bruno, Marco J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-01-2005; Lippincott Williams & Wilkins
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Common Bile Duct Diseases - etiology; Common Bile Duct Diseases - surgery; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Drainage - methods; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pancreatitis - complications; Prognosis; Retrospective Studies; Stents; Treatment Failure; Treatment Outcome; Biliary tract; stents; Pancreatitis; Stenosis; Instrumentation therapy; Long term; Stent; Drainage; constriction; Chronic; Bypass; common bile duct; Surgery; chronic disease; Digestive diseases; Endoscopy; Pancreatic disease
• DOI: 10.1097/00042737-200501000-00019
• EISSN: 1473-5687
• ISSN: 0954-691X

OBJECTIVESEndoscopic stent therapy is an established treatment modality for postoperative biliary strictures. At present, biliary stenting is also widely applied in chronic pancreatitis (CP), but results regarding long-term outcome are scarce.
METHODSAll CP patients who underwent endoscopic biliary drainage of a benign stricture in our hospital between 1987 and 2000 were included in this retrospective study.
RESULTSFifty-eight CP patients underwent biliary stenting (median age, 54 years; 44 male). The procedure-related mortality rate was 2% and the complication rate 4%. Median follow-up was 45 months (range, 0-182 months). Endoscopic treatment was successful in 22 patients (38%). Concomitant acute pancreatitis was the only factor identified as predictive of a successful outcome by multivariate analyses. Subanalysis of these 12 patients revealed a success rate of 92%, as opposed to 24% in cases without acute inflammation. In this latter group, continued stenting beyond a 1-year period almost never resulted in additional stricture resolvement. If stricture resolution was accomplished, however, no recurrences were observed.
CONCLUSIONSFor biliary strictures due to CP, without evidence of concomitant acute pancreatitis, the long-term success rate of endoscopic therapy is poor and only one out of four strictures is treated successfully. When a biliary stricture has not resolved after 1 year of endoscopic stenting, surgery should be considered.