Endoscopic treatment of sphincterotomy-related biliary strictures (SRBS) by using sequental insertion of multiple stents

Background: Late complications of endoscopic biliary sphincterotomy (EBS) are orifitial stenosis (OS) and SRBS. Re-sphincterotomy is a safe treatment of OS. However, in SRBS, the narrowed distal common bile duct (CBD) segment may extend to the proximal intraduodenal part of CBD. Therefore, SRBS-related long strictures cannot be treated with repeated EBS.

Aim: We evaluated the efficacy of multiple biliary stent insretion in the treatment of SRBS. Patients: In 1998, we enrolled 20 SRBS cases (female/male: 18/2; mean age: 61 years [36–81]; mean SRBS length: 12.4mm [11–20]), and followed up until 2003. Since all patients had choledocholithiasis-related biliary-type pain, cholestasis and dilated CBD, cholecystectomy and EBS had performed 12.5 years (0.75–50) and 47 months (2–200) before enrollment.

Methods: In our prospective study, endoscopic treatment of SRBS consisted of sequential insertion of increasing number and diameter plastic stents in 3-months intervals until the resolution of SRBS. Then, all stents were removed.

Results: After an average of 9.9 months (3–22) stenting period and 18.8 French (10–30) maximum diameter, eighteen patients (90%) remained stent-free for 17.2 months (range: 2–36). Two patients (10%) had recurrent stricture after 18 months (10–24), and currently they have stents in place. We found correlation between the overall stenting time and the time-interval elapsed after EBS (r2=0.42, p<0.05). The initial CBD diameter predicted the total dilating diameter required to resolve SRBS (r2=0.63, p<0.05).

Conclusion: SRBS needs different treatment than post-EBS OS. Sequential insertion of increasing number of biliary stents is an effective treatment of SRBS, and offers an adequate modality for medium-term intervals.