Long-term prognosis of patients with endoscopically treated postoperative bile duct stricture and bile duct stricture due to chronic pancreatitis.
OBJECTIVE
To compare the outcome of endoscopic therapy for postoperative benign bile duct stricture and benign bile duct stricture due to chronic pancreatitis, including long-term prognosis.


METHODS
The subjects were 20 patients with postoperative benign bile duct stricture and 13 patients with bile duct stricture due to chronic pancreatitis who were 2 years or more after initial therapy. The patients underwent transpapillary drainage with tube exchange every 3 to 6 months until being free from the tube. Successful therapy was defined as a stent-free condition without hepatic disorder.


RESULTS
Endoscopic therapy was successful in 90% (18/20) of the patients with postoperative bile duct stricture. The stent was removed (stent free) in 100% (20/20) of the patients, but jaundice resolved in only 10% (2/20) of patients while biliary enzymes kept increasing. Restructure occurred in 5% (1/20) of the patients, but after repeat treatment the stent could be removed. In patients with bile duct stricture due to chronic pancreatitis the therapy was successful in only 7.7% (1/13) of the patients; the stent was retained in 92.3% (12/13) of the patients during a long period. Severe acute pancreatitis occurred in 3.0% (1/33) of the patients as an accidental symptom attributable to endoscopic retrograde cholangiopancreatography (ERCP); however, it remitted after conservative treatment.


CONCLUSIONS
Our results further confirm the usefulness of endoscopic therapy for postoperative benign bile duct strictures and good long-term prognosis of the patients.
Sakai
Yuji
Y
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan. sakai4754@yahoo.co.jp
Tsuyuguchi
Toshio
T
Ishihara
Takeshi
T
Yukisawa
Seigo
S
Sugiyama
Harutoshi
H
Miyakawa
Kaoru
K
Kuroda
Yasuhisa
Y
Yamaguchi
Taketo
T
Ozawa
Shinichi
S
Yokosuka
Osamu
O
D000328:Adult; D000368:Aged; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome