Background and study aims: Endoscopic
stenting is a recognized treatment of postcholecystectomy biliary strictures.
Large multicenter reports of its long-term efficacy are lacking. Our aim was to
analyze the long-term outcomes after stenting in this patient population, based
on a large experience from several centers in France.
Methods: Members of the French Society of
Digestive Endoscopy were asked to identify patients treated for a common bile
duct postcholecystectomy stricture. Patients with successful stenting and
follow-up after removal of stent(s) were subsequently included and analyzed.
Main outcome measures were long-term success of endoscopic stenting and related
predictors for recurrence (after one stenting period) or failure (at the end of
follow-up).
Results: A total of 96 patients were eligible
for inclusion. The mean number of stents inserted at the same time was 1.9
± 0.89 (range1 – 4). Stent-related morbidity
was 22.9 % (n = 22). The median duration of
stenting was 12 months (range 2 – 96 months). After a mean
follow-up of 6.4 ± 3.8 years (range 0 – 20.3
years) the overall success rate was 66.7 %
(n = 64) after one period of stenting and
82.3 % (n = 79) after additional treatments.
The mean time to recurrence was 19.7 ± 36.6 months. The most
significant independent predictor of both recurrence and failure was a
pathological cholangiography at the time of stent removal.
Conclusion: Endoscopic stenting helps to
avoid surgery in more than 80 % of patients bearing
postcholecystectomy common bile duct strictures. However, a persistent anomaly
on cholangiography at the time of stent removal is a strong predictor of
recurrence and may lead to consideration of surgery.
References
frederic.prat@cch.aphp.fr
