title: Endoscopic management of post-laparoscopic cholecystectomy biliary strictures. Long-term outcome in a multicenter study.
abstract: OBJECTIVE
  The aim of this retrospective study was to assess the long term results of long-lasting endoscopic stenting for benign biliary strictures related to laparoscopic cholecystectomy. Additional biological and morphological data were collected from these patients during follow-up.
  
  
  METHODS
  Patients undergoing ERCP for post-laparoscopic cholecystectomy biliary stricture in one of the three participating centers between 1990 and December 2001 were identified. Only patients with successful endoscopic stenting were subsequently included and analyzed. Follow-up data were obtained from referring centers, general practitioners and patients or relatives. Hepatic blood tests and abdominal ultrasound were proposed to all the patients who had not undergone further treatments after stent removal.
  
  
  RESULTS
  Eight-eight patients had undergone ERCP for benign biliary stricture related to laparoscopic cholecystectomy. Stenting failed in 19 patients. Balloon dilatation alone was used in four patients. Strictures were successfully stented in 65 patients. The mean number of stents inserted at the same time was 1.6. The mean duration of stenting was 14 months (range 1-120 months). Eighteen patients (28%) developed biliary or pancreatic symptoms during stenting. ERCP was considered satisfactory at the end of stenting (i.e. no remaining stricture or minor remaining change on ERCP) in 45 patients (69%). Twenty-two patients were lost to follow-up. Twenty-nine out of forty-three patients (67%) remained symptom-free with normal updated blood tests and abdominal ultrasound during a mean follow-up of 28 months (range 12-117 months) after stent removal. None of the patients with a normal ERCP at the end of stenting developed stricture recurrence during follow-up. Eleven patients were operated (8 with persistence of stricture, 2 for stricture recurrence up to 63 months after stent removal, 1 for pancreatitis).
  
  
  CONCLUSIONS
  Based on clinical, morphological and biological criteria, a long-term success was obtained in 70% of patients with post-laparoscopic cholecystectomy benign biliary strictures, after several months of endoscopic stenting.
authors.affiliation: Service d'Hépato-Gastroentérologie, CHU Bicêtre.
authors.forename: Carmen
authors.initials: C
authors.lastname: Kassab
authors.forename: Frédéric
authors.initials: F
authors.lastname: Prat
authors.forename: Claude
authors.initials: C
authors.lastname: Liguory
authors.forename: Bruno
authors.initials: B
authors.lastname: Meduri
authors.forename: Béatrice
authors.initials: B
authors.lastname: Ducot
authors.forename: Jacques
authors.initials: J
authors.lastname: Fritsch
authors.forename: André Daniel
authors.initials: AD
authors.lastname: Choury
authors.forename: Gilles
authors.initials: G
authors.lastname: Pelletier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000473:pathology*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002404:Catheterization; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome