Biliary manometry versus clinical trial: value as predictors of success after treatment of biliary tract strictures.
OBJECTIVE
To evaluate the biliary manometric-perfusion test (BMPT) and clinical trial as predictors of long-term success after percutaneous and surgical treatment of biliary tract strictures.


METHODS
After percutaneous intervention or surgical repair of extrahepatic bile duct strictures, 43 patients underwent long-term biliary intubation (mean, 13 months) with 61 internal-external stents. Before removal of the stents, all 43 patients underwent a BMPT (n = 65) and 24 underwent a 2-3-week clinical trial (n = 27) with stents positioned above the treated region. Patients were followed up 1-46 months (mean, 16 months) after stent removal, with clinical outcome determined by means of physical examination, biochemical evaluation, chart review, and telephone interview.


RESULTS
With logistic regression analysis, the BMPT and clinical trial were shown to have equal predictive value in determining treatment success or failure. Eighty-four percent of the clinical outcomes were correctly predicted with BMPT, versus 88% for the clinical trial. Kaplan-Meier survival curve analysis demonstrated the probability of remaining stricture free at 1 year after passing a BMPT and after passing a clinical trial to be 90% and 86% (P = .55), respectively.


CONCLUSIONS
BMPT and clinical trial have similar capabilities in the prediction of long-term patency after treatment of benign biliary tract strictures, but the BMPT is less costly and time consuming for the patient.
Savader
S J
SJ
Department of Radiology, Johns Hopkins Hospital, Baltimore, MD 21287.
Cameron
J L
JL
Pitt
H A
HA
Venbrux
A C
AC
Trerotola
S O
SO
Chen
M C
MC
Lund
G B
GB
Mitchell
S E
SE
Osterman
F A
FA
D000713:Anastomosis, Roux-en-Y; D002404:Catheterization; D001651:Cholestasis, Extrahepatic / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D002986:Clinical Trials as Topic; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007440:Intubation; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000601:surgery; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome