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DOI: 10.1055/a-1873-0961
Benefit of endoscopic stenting for dominant strictures in patients with primary sclerosing cholangitis
Abstract
Background and study aims Dominant strictures (DS) occur in up to 60 % of patients with primary sclerosing cholangitis (PSC). Data regarding the long-term effects of stenting vs. dilation remain limited. The aim of this study was to compare the two treatment modalities in terms of transplantation-free survival.
Patients and methods This single-center, retrospective study examined patients with PSC and DS treated endoscopically with a minimum of 1 year follow-up. Patients were divided into two cohorts: 1) those who received dilation alone; and 2) those who received both dilation and stenting. The primary outcome was transplantation-free survival, defined as time after index ERCP to liver transplantation.
Results In all, 169 patients (54 in dilation cohort, 115 in stenting cohort) were included. The stenting cohort had a significantly higher Mayo PSC Risk Score (1.8 ± 1.1 vs. 0.9 ± 1.2) and presented with cholangitis more frequently (22.6 % vs. 1.9 %). During a follow-up period of 1198 person-years, 69 (40.8 %) patients received transplantation at a mean of 3.4 (± 2.9) years. There was no difference in transplantation rate in the stenting cohort [68 (95 % CI 5.2–8.8) per 100 person-years] compared to the dilation cohort [3.7 (95 % CI 2.1–6.0) per 100 person-years] and no difference in risk for transplantation (dilation cohort adjusted hazards ratio 0.67, 95 % CI 0.33–1.32).
Conclusions Despite a higher Mayo Risk Score in the stenting group, there was no difference in transplantation-free survival between patients managed with stenting vs. dilation alone. Stenting, therefore, may offer benefit in patients with advanced PSC and DS.
Publikationsverlauf
Eingereicht: 03. Januar 2022
Angenommen nach Revision: 09. Juni 2022
Accepted Manuscript online:
09. Juni 2022
Artikel online veröffentlicht:
14. September 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
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References
- 1 Lazaridis KN, LaRusso NF. Primary sclerosing cholangitis. N Engl J Med 2016; 375: 1161-1170
- 2 Chapman MH, Thorburn D, Hirschfield GM. et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut 2019; 68: 1356-1378
- 3 Okolicsanyi L, Fabris L, Viaggi S. et al. Primary sclerosing cholangitis: clinical presentation, natural history and prognostic variables: an Italian multicentre study. The Italian PSC Study Group. Europ J Gastroenterol Hepatol 1996; 8: 685-691
- 4 Tischendorf JJ, Hecker H, Kruger M. et al. Characterization, outcome, and prognosis in 273 patients with primary sclerosing cholangitis: A single center study. Am J Gastroenterol 2007; 102: 107-114
- 5 Kaya M, Petersen BT, Angulo P. et al. Balloon dilation compared to stenting of dominant strictures in primary sclerosing cholangitis. Am J Gastroenterol 2001; 96: 1059-1066
- 6 Anonymous. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Journal of hepatology 2017; 66: 1265-1281
- 7 Gotthardt DN, Rudolph G, Klöters-Plachky P. et al. Endoscopic dilation of dominant stenoses in primary sclerosing cholangitis: outcome after long-term treatment. Gastrointest Endosc 2010; 71: 527-534
- 8 Ponsioen CY, Lam K, van Milligen de Wit AW. et al. Four years experience with short term stenting in primary sclerosing cholangitis. Am J Gastroenterol 1999; 94: 2403-2407
- 9 Silvis SE, Nelson DB, Meier PB. Ten-year response to stenting in a patient with primary sclerosing cholangitis. Gastrointest Endosc 1998; 47: 83-87
- 10 van Milligen deWit AW, Rauws EA, van Bracht J. et al. Lack of complications following short-term stent therapy for extrahepatic bile duct strictures in primary sclerosing cholangitis. Gastrointest Endosc 1997; 46: 344-347
- 11 van Milligen de Wit AW, van Bracht J, Rauws EA. et al. Endoscopic stent therapy for dominant extrahepatic bile duct strictures in primary sclerosing cholangitis. Gastrointest Endosc 1996; 44: 293-299
- 12 Ponsioen CY, Arnelo U, Bergquist A. et al. No superiority of stents vs balloon dilatation for dominant strictures in patients with primary sclerosing cholangitis. Gastroenterology 2018; 155: 752-759.e755
- 13 Kim WR, Poterucha JJ, Wiesner RH. et al. The relative role of the Child-Pugh classification and the Mayo natural history model in the assessment of survival in patients with primary sclerosing cholangitis. Hepatology (Baltimore, Md) 1999; 29: 1643-1648
- 14 Kim WR, Therneau TM, Wiesner RH. et al. A revised natural history model for primary sclerosing cholangitis. Mayo Clinic Proceed 2000; 75: 688-694
- 15 Chathadi KV, Chandrasekhara V, Acosta RD. et al. The role of ERCP in benign diseases of the biliary tract. Gastrointest Endosc 2015; 81: 795-803
- 16 Rupp C, Hippchen T, Bruckner T. et al. Effect of scheduled endoscopic dilatation of dominant strictures on outcome in patients with primary sclerosing cholangitis. Gut 2019; 68: 2170-2178
- 17 Sbeit W, Khoury T, Goldin E. et al. Three-months duration of fully-covered metal stent for refractory dominant extra-hepatic biliary stricture among primary sclerosing cholangitis patients: efficacy and safety. Surg Endosc 2022; 36: 2412-2417