title: Long-term outcome in patients with benign biliary strictures treated endoscopically with multiple stents.
abstract: BACKGROUND
  The long-term efficacy of sequential insertion of multiple plastic stents for benign biliary strictures is poorly defined. The aims of this study were to evaluate the long-term outcome (bile duct patency, complications) of this therapy and to identify predictors of a good outcome.
  
  
  METHODS
  Retrospective review of 29 cases of benign biliary strictures treated with sequential plastic stent insertion in progressively increasing numbers and/or of increasing diameter.
  
  
  RESULTS
  Stricture etiology was as follows: postoperative 19 (66%), chronic pancreatitis 9 (31%), and idiopathic 1 (3%). Therapy succeeded in 18 patients (62%) (mean follow-up 48.0 [11.56] months after stent removal). Therapy failed in 11 patients (38%) (mean interval to failure 11.59 [9.79] months after stent removal). The 2 groups of patients in which therapy failed had either a hilar stricture (n = 4, 25% success) or distal common bile duct stricture caused by chronic pancreatitis (n = 9, 44% success). In the remaining cases, therapy succeeded in 13 of 16 (81% success). The observed differences in success rate among subgroups were not statistically significant. There were no ERCP-related deaths. One episode of mild pancreatitis and 2 episodes of cholangitis developed during 126 ERCPs over a period of stent insertion of 36 patient years.
  
  
  CONCLUSIONS
  In selected patients with benign biliary strictures, sequential endoscopic insertion of multiple biliary stents may lead to long-term success that could be equal to or superior to surgery with minimal morbidity. Hilar strictures and those caused by chronic pancreatitis appear to respond poorly to this therapy.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida 32610, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Draganov
authors.forename: Brenda
authors.initials: B
authors.lastname: Hoffman
authors.forename: William
authors.initials: W
authors.lastname: Marsh
authors.forename: Peter
authors.initials: P
authors.lastname: Cotton
authors.forename: John
authors.initials: J
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000473:pathology* / Q000601:surgery*; D003251:Constriction, Pathologic / Q000473:pathology / Q000601:surgery; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors