Long-term outcome of endoscopic multiple stenting for postoperative benign biliary stenosis

Introduction: One of the most important targets of endoscopic biliary stenting is the postoperative biliary stricture. Endoscopic stenting with multiple endoprothesis for a long period can provide definitive resolution of biliary duct stenosis, however, long term follow-up results are lacking.

Patients: 33 patients (age range: 28–86yrs) were treated for postoperative biliary duct stricture (PBDS). 22 of them were previously reported at 15.2 months of mean follow-up time and continued to be checked regularly and 11 patients were followed-up for only 2 years since that time. Various etiologies of PBDS were found: T-tube common bile duct (CBD) drainage (15 pts), choledochoplasty (2 pts), intraoperative bile duct injury (16 pts). In 28 cases the stricture was located in the CBD or common hepatic duct; in 5 cases the proximal bile duct was also involved.

Methods: Multiple 10 F teflon plastic stents were applied into the CBD or common hepatic duct stricture (1 stent: 1 pt, 2 stents: 9 pts, 3 stents: 14 pts, 4 stents: 4 pts) to achieve stepwise calibration of the stricture. Long 10 F stents were used to dilate the more proximal lesions. Multiple stenting required repeated ERCPs with nasobiliary lavage. In cases of stent clogging indicated by US and/or laboratory tests replacement or removal (at 1.5 year) of the stents was performed.

Results: Endoscopic stent placement was successful in all cases technically. In 3 patients it proved to be unsuccessful, one patient had to be operated on for high hilar stricture, one patient died because of septic complications, and in one case we had to reapply another three stents after 78 months because of restenosis. From the remaining 30 cases, 6 patients are still with stents, 24 of them are without stents. The median dilation time was 15 (range 1–48) months. During the average 24.5 (range 1–77) months of follow up no restenosis was observed, all patients are doing well, with normal serum alcaline phosphatase values without stents.

Conclusions: Multiple endoscopic stenting is a very promising long-term treatment option for postoperative bile duct stenosis.