title: Long-term outcomes of a benign biliary stricture protocol.
abstract: OBJECTIVE
  To evaluate long-term outcomes of a structured protocol for percutaneous treatment of benign biliary stricture.
  
  
  METHODS
  Seventy-one patients (37 men, 34 women; mean age, 54 y; age range, 23-84 y) entered the protocol, which consisted of staged upsizing of internal/external biliary catheters, balloon dilation (nominally 8 mm), and prolonged stent treatment (6 mo) at maximal catheter size (nominally 18 F). It concluded with a capping trial and catheter removal if the stricture remained patent. Fifty-three patients completed the protocol and 18 did not (6 died, 6 underwent alternative treatment, 4 were lost to follow-up, and 2 underwent repeat transplantation). Stricture features, treatment parameters, complications, and outcomes were reviewed, and Kaplan-Meier analysis was conducted.
  
  
  RESULTS
  Strictures were anastomotic in 45 patients (64%), intrahepatic in 14 (20%), extrahepatic in 7 (10%), and multiple (intra- and extrahepatic) in 5 (7%). A right-sided approach was used in 47 patients (66%) patients, a left-sided approach in 18 (25%), and a bilateral approach in 6 (9%). Forty-six patients who entered the protocol (65%) and 46 patients who completed the protocol (87%) showed stricture patency. Four of 7 patients in whom a capping trial failed underwent surgical revision, 2 required chronic biliary drainage, and 1 received a metal stent. Follow-up (range, 0-12 y; mean, 4.7 y) was obtained for 42 of 53 patients who completed the protocol (79%). Kaplan-Meier analysis showed stricture patency probabilities of 84% at 1 year after treatment, 78% at 2 years, 74% at 5 years, and 67% at 10 years.
  
  
  CONCLUSIONS
  Use of a structured protocol for the percutaneous treatment of benign biliary strictures yields durable long-term results, suggesting that percutaneous treatment is an effective therapy.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: DePietro
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Dagli
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104. Electronic address: streroto@uphs.upenn.edu.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D057785:Catheters; D016009:Chi-Square Distribution; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004106:Dilatation; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult