Long-term results of endoscopic drainage of common bile duct strictures in chronic pancreatitis.
OBJECTIVE
Endoscopic stent therapy is an established treatment modality for postoperative biliary strictures. At present, biliary stenting is also widely applied in chronic pancreatitis (CP), but results regarding long-term outcome are scarce.


METHODS
All CP patients who underwent endoscopic biliary drainage of a benign stricture in our hospital between 1987 and 2000 were included in this retrospective study.


RESULTS
Fifty-eight CP patients underwent biliary stenting (median age, 54 years; 44 male). The procedure-related mortality rate was 2% and the complication rate 4%. Median follow-up was 45 months (range, 0-182 months). Endoscopic treatment was successful in 22 patients (38%). Concomitant acute pancreatitis was the only factor identified as predictive of a successful outcome by multivariate analyses. Subanalysis of these 12 patients revealed a success rate of 92%, as opposed to 24% in cases without acute inflammation. In this latter group, continued stenting beyond a 1-year period almost never resulted in additional stricture resolvement. If stricture resolution was accomplished, however, no recurrences were observed.


CONCLUSIONS
For biliary strictures due to CP, without evidence of concomitant acute pancreatitis, the long-term success rate of endoscopic therapy is poor and only one out of four strictures is treated successfully. When a biliary stricture has not resolved after 1 year of endoscopic stenting, surgery should be considered.
Cahen
Djuna L
DL
Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands. D.L.Cahen@AMC.UVA.NL
van Berkel
Anne-Marie M
AM
Oskam
Daphne
D
Rauws
Erik A J
EA
Weverling
Gerrit Jan
GJ
Huibregtse
Kees
K
Bruno
Marco J
MJ
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002908:Chronic Disease; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome