Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up.
BACKGROUND
Endoscopic dilation of postoperative biliary strictures with increasing numbers of stents was first described by our group in 2001 with promising results after a long-term follow-up (mean 4 years).


OBJECTIVE
To verify results of endoscopic treatment of postoperative biliary strictures at a very-long-term follow-up.


METHODS
Single center, follow-up study.


METHODS
Tertiary-care, academic referral center.


METHODS
A group of 42 patients from our 2001 study, who had undergone endoscopic dilation of postoperative biliary strictures with the multiple endoscopic stenting technique, underwent systematic follow-up. The last telephone follow-up was done in September 2009.


METHODS
Clinical conditions and the occurrence of new biliary symptoms during the follow-up period were assessed, and results of the most recent liver function tests and abdominal US were recovered.


METHODS
Occurrence of cholangitis and liver function test evaluation during the follow-up period.


RESULTS
Of the 40 patients who were alive at the end of the study published in 2001, 5 (12.5%) died of unrelated causes after a mean of 6.7 years (range 3-13.3 years) from the end of treatment, without further biliary symptoms. The overall mean follow-up time for the remaining 35 patients (87.5%) was 13.7 years (range 11.7-19.8 years). Seven patients (20%) experienced recurrent acute cholangitis after a mean of 6.8 years (range 3.1-11.7 years) from the end of treatment. All 7 of these patients underwent ERCP. Four of the 7 patients had postoperative biliary stricture recurrence (n = 4/35, 11.4%) that was retreated endoscopically with placement of stents, and the other 3 patients had common bile duct stones (n = 3/35, 8.6%) that were extracted. No stricture or bile duct stone recurrences after retreatment were recorded after a mean follow-up period of a further 7.1 years (range 2.5-12.1 years). Twenty-eight patients remained asymptomatic with normal liver function test results and abdominal US results after a mean follow-up period of 13.7 years (range 11.7-19.8 years).


CONCLUSIONS
Telephone follow-up.


CONCLUSIONS
Results of multiple endoscopic stenting for postoperative biliary strictures remain excellent even after a very-long-term follow-up. The stricture recurrence rate is low, and recurrences can be retreated endoscopically.
Costamagna
Guido
G
Digestive Endoscopy Unit, Catholic University, Rome, Italy. gcostamagna@rm.unicatt.it
Tringali
Andrea
A
Mutignani
Massimiliano
M
Perri
Vincenzo
V
Spada
Cristiano
C
Pandolfi
Monica
M
Galasso
Domenico
D
D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000628:therapy; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002779:Cholestasis / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D011183:Postoperative Complications / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography