Biliary Stenting in Benign Biliary Stenosis Complicating Chronic Calcifying Pancreatitis

Abstract

This a retrospective study of 19 patients presenting with chronic pancreatitis and benign stenosis of the common bile duct, who were followed up for periods ranging from 13 months to 48 months after biliary stenting (average 18 months). There were 18 men and one woman, aged between 38 and 65 years (average 49 years). The mean duration of the disease before stenting was seven years (range 1-25 years). Symptoms were present in ten patients: obstructive jaundice in four cases, cholangitis in three cases, and biliary colic in three cases. Nine patients without clinical complaints presented with chronic cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP) showed 15 long, regular stenoses of the intrapancreatic course of the common bile duct, three short stenoses located at the upper margin of the head of the pancreas, and one bilary stenosis associated with peripheral compression by a cyst of the head of the pancreas. Forty endoscopic biliary stenting procedures were performed in the 19 patients over a six-year period. Successful insertion of the prosthesis was achieved in 39 cases. Two complications occurred: one duodenal ulceration and one stent migration into the bile duct. The mean duration of biliary stenting was ten months. Only two patients (10 %) had complete clinical, biological, and radiological recovery. Complete failure of biliary stenting was observed in six patients (31 %). Eleven patients (59 %) had partial results: six (31 %) had biological improvement although the biliary stricture persisted, and five were clinically asymptomatic but had cholestasis, and still presented with biliary stenosis in four cases.

Biliary stenting of benign biliary strictures complicating chronic calcifying pancreatitis seems to be only a temporary treatment, except perhaps for short, localized biliary strictures. Because of the low morbidity rate and the rare failure of stent insertion, it can be a transition therapy for inoperable patients or for those awaiting a sufficient dilation of the main pancreatic duct allowing the performance of surgery with both biliary and pancreatic digestive diversion.