title: Endoscopic treatment of patients with bile duct stricture after cholecystectomy: factors predicting recurrence in the long term.
abstract: OBJECTIVE
  Endoscopic treatment is effective in the treatment of patients with bile duct injury after cholecystectomy. We aimed to investigate the long-term results of endoscopic treatment, factors predicting the recurrence of the stricture, and to determine the optimal endoscopic treatment.
  
  
  METHODS
  The study was a retrospective cohort analysis and conducted at a tertiary referral center in patients with major bile duct injury (Strasberg E1-4 and E5 patients with main bile duct injury). Patients with minor injury (Luschka and cystic duct leakage), complete transection, and isolated aberrant bile duct injuries were excluded.
  
  
  RESULTS
  The study group included 156 patients. The median follow-up period after stent removal was 6.5 years (range 1-16.5). Recurrence was seen in 18 patients (11 %) after a median duration of 9 months (range 2-96). Multivariate regression analysis revealed that the most important factors predicting the success of endoscopic treatment were: Rome type of treatment (inserting increasing number of stents every 3-4 months) (odds ratio 23.8, 95 % CI 1.46-390.7, p = 0.026) instead of Amsterdam-type treatment (replacing two 10F biliary stents every 3-4 months) and dilation of the stricture diameter to at least 76 % of the common bile duct diameter at the end of stent treatment (odds ratio 25.9, 95 % CI 2.46-272.7, p = 0.007).
  
  
  CONCLUSIONS
  Endoscopic treatment is an effective method in the treatment of patients with bile duct stricture after cholecystectomy. Inserting multiple stents as much as possible without leaving a scar in the bile ducts should be aimed.
authors.affiliation: Department of Gastroenterology, Sakarya University, Sakarya, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: Selçuk
authors.initials: S
authors.lastname: Dişibeyaz
authors.forename: Bülent
authors.initials: B
authors.lastname: Ödemiş
authors.forename: Aydın Şeref
authors.initials: AŞ
authors.lastname: Köksal
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Küçükay
authors.forename: Nurgül
authors.initials: N
authors.lastname: Şaşmaz
authors.forename: Burhan
authors.initials: B
authors.lastname: Şahin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D002779:Cholestasis / Q000209:etiology* / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome