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DOI: 10.1055/s-2003-40548
Self-expandable Metal Mesh Stents for Common Bile Duct Stenosis in Chronic Pancreatitis: Retrospective Evaluation of Long-term Follow-up and Clinical Outcome of a Pilot Study
Langzeitergebnisse der Therapie mit selbstexpandierenden Metallstents bei Patienten mit chronischer Pankreatitis und symptomatischer distaler Gallengangstenose: Retrospektive Ergebnisse einer PilotstudiePublication History
Manuscript received: 27. January 2003
Accepted after revision: 31. March 2003
Publication Date:
14 July 2003 (online)
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Zusammenfassung
Hintergrund: Eine symptomatische distale Choledochusstenose tritt bei 10-30 % aller Patienten mit chronischer Pankreatitis auf. Patienten mit Komorbiditäten und Kontraindikationen gegen eine Operation bedürfen der endoskopischen Langzeittherapie, meist mit Plastikprothesen. Der Stellenwert von Metallstents als mögliche Alternative zu Plastikprothesen bei benignen distalen Gallengangstenosen ist noch ungeklärt. Methodik: Bei 6 Patienten mit chronischer Pankreatitis und symptomatischer distaler Choledochusstenose wurde ein selbstexpandierender Metallstent (Wallstent®) implantiert. Alle Patienten waren primär erfolglos mit Plastikprothesen behandelt und nachfolgend als inoperabel eingestuft worden. Ergebnisse: Die initiale Therapie mit Plastikprothesen wurde im Median 14 Monate durchgeführt. Der Wallstent konnte bei allen Patienten erfolgreich implantiert werden und der Nachbeobachtungszeitraum lag bei 58 Monaten. Die mediane Offenheitsrate der Wallstents betrug 20 Monate. Im Langzeitverlauf profitierten 2/6 Patienten von der Therapie mit einem Wallstent, bei 4/6 Patienten wurden endoskopische Sekundärmaßnahmen notwendig. Schlussfolgerungen: Für eine Untergruppe von Patienten mit symptomatischer distaler Choledochusstenose und Versagen der endoskopischen Therapie mit Plastikprothesen kann die Einlage eines selbstexpandierenden Metallstents eine sichere und effektive Drainagemaßnahme bedeuten. Aufgrund der begrenzten Patientenzahl und des inhomogenen Patientengutes muss der Erfolg dieser Therapie im Langzeitverlauf in größeren Studien untersucht werden.
Abstract
Background: Symptomatic common bile duct strictures are frequently seen in the course of severe chronic pancreatitis with a reported incidence of 10-30 %. The exact role of endoscopic stenting with metal prostheses as definitive treatment has not yet been clearly defined. Methods: Six patients with symptomatic distal common bile duct stricture in the setting of chronic pancreatitis were treated with a self-expandable metal stent in an attempt to achieve permanent drainage. All cases were approached non-operatively and underwent prior unsuccessful treatment with plastic prostheses. Results: The patients received a self-expandable metal Wallstent® after a median follow-up of 14 months of plastic stenting. The median follow-up time was 58 months and the stents remained open for a median time of 20 months, respectively. Overall, in 2 of 6 cases the metal stent therapy was successful while 4 of 6 patients required additional endoscopic procedures. Conclusions: Self-expandable metal stents could be useful and adequate in patients who suffer from symptomatic obstructive jaundice due to chronic pancreatitis. However, they provide acceptable dilation of the common bile duct for only a limited period of time. Overall, endoscopic stenting with self-expandable metal stents seems to be an advantageous treatment only for a subgroup of patients who are unfavorable candidates for surgical drainage. To clarify the role of the endoscopic approach, prospective trials with homogenous and larger patient numbers are necessarily in the future.
Schlüsselwörter
chronische Pankreatitis - benigne Gallengangstenose - endoskopische Stenttherapie - selbstexpandierender Metallstent
Key words
Chronic pancreatitis - benign bile duct stricture - endoscopic stenting - self expandable metal mesh stent
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Dr. med. Axel Eickhoff
Medical Department C,
Klinikum Ludwigshafen
Bremserstr. 79
D-67063 Ludwigshafen
Email: MedCLu@t-online.de