title: Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis.
abstract: OBJECTIVE
  To investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors.
  
  
  METHODS
  Ten consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared.
  
  
  RESULTS
  Endoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mmvs13.7 ± 2.2 mm, respectively,P= 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm,P= 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo.
  
  
  CONCLUSIONS
  Sequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy.
authors.affiliation: Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohyama
authors.affiliation: Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mikata
authors.affiliation: Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
authors.forename: Harutoshi
authors.initials: H
authors.lastname: Sugiyama
authors.affiliation: Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Yasui
authors.affiliation: Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
keywords: Biliary stent; Biliary stricture; Chronic pancreatitis; Endoscopy; Pancreatic stone