Long-term results of self-expandable metal stents for benign biliary strictures

Background: Benign biliary strictures/BBS/are being increasingly treated with endoscopic techniques. Endoscopic treatment of benign bile duct strictures is technically challenging. Surgery has been the traditional treatment, but there is increasing desire for minimally invasive endoscopic therapy. At present, endoscopy has become the first line approach for the therapy of post-operative, and/or pancreatic benign biliary strictures.

Patients and methods: Our department in the last 8 years we treated endoscopically 36 BBS patients/22 female (61%), 14 male (39%)/with self-expandable metal stents/SEMS/. The causes of BBS were chronic calcifying pancreatitis/12 pts (33%)/, autoimmun pancreatitis/2 pts (5,5%)/, recurrent cholangitis after surgical choledocho-duodenostomy/3 pts (8,5%)/and post-operative bile duct stricture – previous open and laparoscopic cholecystectomy-/19 pts (53%)/. The self-expandable metal stent placement was technically successful in all pts/100%/. No procedure-related mortality was observed, procedure-related or stent associated complication was in 2 pts/septic cholangitis and liver abscess/, treated endoscopically: naso-biliary drainage and stent removal in 1 pts.

Results: After placement of SEMS 100% patients had relief of jaundice and cholangitis at completion of follow-of period/mean of 3,5 years/. One patient have lost of follow-up, and the other one died an acute myocardial infarction. After a mean follow-up of 8 months, 12 pts/33%/, required another procedure due to stent occlusion. Therapy during the repeat procedure 11 pts consisted of insertion 1 or 2 plastic stent within the lumen of the SEMS, and one patient needed percutan-transhepatic drainage.

Conclusions: Endoscopic drainage of biliary obstruction by SEMS provides good long-term results in selected patients. To identify patients who benefit most from SEMS insertion, further, prospective randomised study are necessary.