Endoscopic stenting of dominant strictures in patients with primary sclerosing cholangitis: When, how, and for how long?

Primary sclerosing cholangitis (PSC) is a progressive cholestatic disease associated with chronic inflammation and fibrosis of the intra-/extra-hepatic bile ducts [1]. Given the lack of adequate medical treatment, the current focus is on management of adverse events (AEs); efforts are made to relieve biliary obstruction [1] [2]. Dominant strictures (DSs) develop in up to 60 % of patients with PSC, associated with impeded biliary drainage that induces progression to cholangitis or liver failure. In such patients, endoscopic balloon dilatation (with or without stenting) is often used to relieve obstructions [3] [4] [5]. Although both methods afford laboratory-assessed and clinical improvements [6] [7] [8] [9], treatment outcomes have varied ([Table 1]).

Table 1 Summary of studies exploring endoscopic treatment of dominant strictures in patients with primary sclerosing cholangitis.

Authors (year)	Patients, n	Study design	Intervention	Stent type	Duration	Study results
Balloon dilatation with/without stenting
Gluck et al. [5] (2008)	84	Retrospective	Endoscopic stenting after balloon dilatation	Plastic stents (7–10F)	Less than 2 weeks (or even shorter, at the discretion of the endoscopist)	Higher transplantation-free survival rates at 3 and 4 years than suggested by the predictive Mayo model (P = 0.021); adverse events in 7.2 %
Gotthardt et al. [7] (2010)	96	Prospective	Balloon dilatation plus stenting (the latter only in five patients with severe cholestasis and cholangitis)	Plastic stents	1–2 weeks	Improvement in the mean bilirubin level of 56 %; adverse events in 3.8 %
Endoscopic stenting after balloon dilatation versus balloon dilatation alone
Kaya et al. [4] (2001)	71	Retrospective	Endoscopic stenting after balloon dilatation in 37 patients (19 treated via a percutaneous approach); balloon dilatation alone in 34 patients	Plastic stents (7–10F)	Median duration 3–6 months	No difference in terms of cholestasis improvement; more adverse events (P = 0.004) in the stenting group; more cholangitis (P = 0.001) in the stenting group
Ponsioen et al. [6] (2018)	65	RCT	Endoscopic stenting after balloon dilatation in 31 patients; balloon dilatation alone in 34 patients	Plastic stents (10F)	Average 7 days (maximum 14 days)	No difference in recurrence-free rate (P = 1.0); More adverse events (P = 0.01) in the stenting group
Han et al. (2022)	169	Retrospective	Endoscopic stenting after balloon dilatation in 115 patients; balloon dilatation alone in 54 patients	Plastic stents (7, 8.5, 10F)	2 months (at the discretion of the endoscopist)	No difference in transplantation-free survival; no difference in terms of clinical improvement

RCT, randomized controlled trial.

Publication History

Article published online:
14 September 2022

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