Endoscopic treatment of benign biliary strictures with self-expandable metal stent

Benign biliary strictures caused by bile duct injury and chronic pancreatitis usually respond sequential insertion of multiple plastic biliary stents. In some cases these stricture cannot be dilated with this method or after initial success the strictures may recur. If these patients unfit for surgery, insertion of self-expandable metal stents may be an alternative. However, there are few data concerning the safety and efficacy of SEMS for the treatment of benign biliary strictures.

Aim: we evaluated the effect of SEMS on the course of benign biliary strictures of various origins.

Patients And Methods: Between 2000 and 2004, nine patients (7 women; mean age: 59 years) underwent SEMS insertion to resolve cholestasis caused by benign biliary strictures. All patients had several session of placement of plastic stents previously, but resolution of the stricture could not be achieved. The follow-up period ranged between 2 and 144 months after SEMS placement. The indications for SEMS insertion were proximal common bile duct stricture by bile duct injury during cholecystectomy and choledochotomy (n=7), distal bile duct stricture of inflammatory origin (n=1) and distal stricture by chronic pancreatitis (n=1).

Results: All SEMS placement were technically successful, and resulted in initial clinical and laboratory improvement in all patients. In 4 patients, no stent-related complications were detected during the entire follow-up period. In 3 cases, recurrent cholestasis and cholangitis due to stent occlusion were observed between a 2 and 12 months period. The stent occlusions and cholangitis required such additional endoscopic procedures as second SEMS insertion in 1 patient (71 months after the initial procedure) and plastic stent placement in 2 patients. There was 1 death caused by severe acute pancreatitis thought to be the complication of ERCP and sphincterotomy.

Conclusions: SEMS therapy can be a safe, provided successful and prolonged biliary drainage in a special group of patients with benign biliary strictures in whom surgical intervention was not possible or desirable.