Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis.
OBJECTIVE
Endoscopic metal stenting (EMS) offers good results in short to medium term follow-up for bile duct stenosis associated with chronic pancreatitis (CP); however, longer follow-up is needed to determine if EMS has the potential to become the treatment of first choice.


METHODS
EMS was performed in eight patients with severe common bile duct stenosis due to CP. After the resolution of cholestasis by endoscopic naso-biliary drainage three patients were subjected to EMS while, the other five underwent EMS following plastic tube stenting. The patients were followed up for more than 5 years through periodical laboratory tests and imaging techniques.


RESULTS
EMS was successfully performed in all the patients. Two patients died due to causes unrelated to the procedure: one with an acute myocardial infarction and the other with maxillary carcinoma at 2.8 and 5.5 years after EMS, respectively. One patient died with cholangitis because of EMS clogging 3.6 years after EMS. None of these three patients had showed symptoms of cholestasis during the follow-up period. Two patients developed choledocholithiasis and two suffered from duodenal ulcers due to dislodgement of the stent between 4.8 and 7.3 years after stenting; however, they were successfully treated endoscopically. Thus, five of eight patients are alive at present after a mean follow-up period of 7.4 years.


CONCLUSIONS
EMS is evidently one of the very promising treatment options for bile duct stenosis associated with CP, provided the patients are closely followed up; thus setting a system for their prompt management on emergency is desirable.
Yamaguchi
Taketo
T
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. yama.take@faculty.chiba-u.jp
Ishihara
Takeshi
T
Seza
Katsutoshi
K
Nakagawa
Akihiko
A
Sudo
Kentarou
K
Tawada
Katsuyuki
K
Kouzu
Teruo
T
Saisho
Hiromitsu
H
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D003135:Common Bile Duct / Q000473:pathology*; D003137:Common Bile Duct Diseases / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000150:complications / Q000473:pathology / Q000628:therapy*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
D000469:Alkaline Phosphatase