Original articleClinical endoscopyEndotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up
Section snippets
Patients and methods
The study group consisted of 42 patients1 who underwent aggressive endoscopic treatment of POBS by use of an increasing number of large-bore plastic stents between December 1987 and December 1997. POBS were classified according to the Bismuth and Lazorthes6 method: 36% had type I strictures, 21% type II, 17% type III, 19% type IV, and 7% type V.
The 42 patients underwent systematic follow-up: all were asked to undergo liver function tests (total and direct bilirubin, aspartate aminotransferase,
Results
No patients were lost to follow-up. Five patients (12.5%) died from unrelated causes (thyroid cancer, pharynx cancer, prostate cancer, heart failure, motorbike accident) after a mean of 6.7 years (range 3-13.3 years, median 6 years, IQR 3-8) from the end of treatment. These patients did not experience further episodes of cholangitis during their lives, and the last liver function test results and abdominal US results were within normal ranges.
The mean follow-up period for the remaining 35
Discussion
POBS need a multidisciplinary approach from diagnosis to treatment. With the advent of laparoscopic cholecystectomy, the incidence of bile duct lesions has increased significantly.7 Patients with POBS are usually healthy and young, but this “benign” event can affect quality of life significantly.8, 9
Three kinds of treatment are available: surgical, endoscopic, and percutaneous. Surgical treatment of POBS should be performed in referral hepatobiliary surgical units because surgical repair may be
References (30)
- et al.
Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents
Gastrointest Endosc
(2001) - et al.
Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents
Gastrointest Endosc
(2002) - et al.
Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents
Gastrointest Endosc
(2004) - et al.
Long-term results of hepaticojejunostomy for benign lesions of the bile ducts
Am J Surg
(1998) - et al.
Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy
Am J Surg
(2008) - et al.
Percutaneous treatment of benign bile duct strictures
Eur J Radiol
(2007) - et al.
Long-term follow-up after biliary stent placement for postoperative bile duct stenosis
Gastrointest Endosc
(2001) Covered self-expanding metal stents in benign biliary strictures: not yet a “new paradigm” but a promising alternative
Gastrointest Endosc
(2008)- et al.
Prospective follow-up of patients with bile duct strictures secondary to laparoscopic cholecystectomy, treated endoscopically with multiple stents
Hepatogastroenterology
(2005) - et al.
Medium-term results of endoscopic treatment of common bile duct strictures in chronic calcifying pancreatitis with increasing numbers of stents
J Clin Gastroenterol
(2004)
Les traumatismes opèratoires de la voie biliaire principaleMonographies de l'Association Francaise de Chirurgie
Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56,591 cholecystectomies
Arch Surg
Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life
Ann Surg
Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment
Endoscopy
Postcholecystectomy bile duct strictures: management and outcome in 130 patients
Arch Surg
Cited by (120)
A practical approach to the endoscopic management of biliary strictures after liver transplantation
2024, Annals of HepatologyPost-operative biliary strictures
2020, Digestive and Liver DiseaseAnastomotic bilio-biliary stricture after adult liver transplantation: A retrospective study over 20 years in a single center
2020, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :Endoscopic therapy of ABS usually requires biliary sphincterotomy, balloon dilatation and stent placement. The use of balloon dilatation alone in early onset anastomotic strictures (the first 2 months following LT) may be effective, but it leads to a high rate of recurrent stricture formation [22,23]. Multiple 10-Fr plastic stents are usually maintained until stricture resolution or for a minimum of 12 months, with stent exchange scheduled every 3–4 months to reduce the chance of stent blockage and cholangitis; this was our main strategy.
Biodegradable versus multiple plastic stent implantation in benign biliary strictures: A systematic review and meta-analysis
2020, European Journal of Radiology
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section; p. 600
If you would like to chat with an author of this article, you may contact Dr Costamagna at [email protected].