title: A comparative study of surgery and endoscopy for the treatment of bile duct stricture in patients with chronic pancreatitis.
abstract: BACKGROUND
  This study aimed to compare the outcomes of endoscopic treatment (ET) and surgical treatment (ST) for common bile duct (CBD) stricture in patients with chronic pancreatitis (CP).
  
  
  METHODS
  From 2004 to 2009, 39 patients (35 men and 4 women; median age, 52 years; range, 38-66 years) were referred for CBD stricture in CP. Of these 39 patients, 33 (85 %) underwent primary ET, and 6 underwent primary ST. Treatment success was defined in both groups as the absence of signs denoting recurrence, with normal serum bilirubin and alkaline phosphatase levels after permanent stent removal in ET group. The follow-up period was longer than 12 months for all the patients.
  
  
  RESULTS
  For the patients treated with ET, the mean number of biliary procedures was 3 (range, 1-10) per patient including extractible metallic stents in 35 % and multiple plastic stents in 65 % of the patients. The mean duration of stent intubation was 11 months. The surgical procedure associated with biliary drainage (4 choledochoduodenostomies, 1 choledochojejunostomy, and 1 biliary decompression within the pancreatic head) was a Frey procedure for five patients and a pancreaticojejunostomy for one patient. The overall morbidity rate was higher in the ST group. The total hospital length of stay was similar in the two groups (16 vs 24 days, respectively; p = 0.21). In terms of intention to treat, the success rates for ST and ET did not differ significantly (83 % vs 76 %; p = 0.08). Due to failure, 17 patients required ST after ET. Event-free survival was significantly longer in the ST group (16.9 vs 5.8 months; p = 0.01). The actuarial success rates were 74 % at 6 months, 74 % at 12 months, and 65 % at 24 months in the ST group and respectively 75 %, 69 %, and 12 % in the ET group (p = 0.01). After more than three endoscopic procedures, the success rates were 27 % at 6 months and 18 % at 18 months.
  
  
  CONCLUSIONS
  For bile duct stricture in CP, surgery is associated with better long-term outcomes than endoscopic therapy. After more than three endoscopic procedures, the success rate is low.
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: Eric
authors.initials: E
authors.lastname: Bartoli
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.forename: Adina
authors.initials: A
authors.lastname: Hanes
authors.forename: Thierry
authors.initials: T
authors.lastname: Yzet
authors.forename: Richard
authors.initials: R
authors.lastname: Delcenserie
mesh_terms: D000328:Adult; D000368:Aged; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000401:mortality / Q000628:therapy; D018572:Disease-Free Survival; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome