ENDOSCOPIC MANAGEMENT OF BILIARY-TRACT STRICTURES IN PRIMARY SCLEROSING CHOLANGITIS

Background and Study Aims: In a subgroup of patients, primary sclerosi ng cholangitis (PSC) is complicated by high-grade focal strictures of the bile ducts, and this can have an unfavorable influence on the natu ral course of the disease, The aim of this study was to evaluate the e fficacy and safety of endoscopic treatment in this selected patient gr oup, Patients and Methods: Twelve symptomatic patients with primary sc lerosing cholangitis and major ductal strictures were included in a pr ospective study of endoscopic treatment, All patients were managed by repeated angioplasty-type balloon dilation and nasobiliary catheter pe rfusion, A minimum of two treatment sessions was used, and therapy was continued until satisfactory reopening of the strictures was obtained , Routine endoscopic follow-up was performed after three, six, 12, 18, and 24 months, and then at yearly intervals, The efficacy of therapy was assessed by evaluating clinical symptoms, laboratory data, and cho langiograms. Results: The long-term follow-up averaged 23 months (rang e: 12-50 months), Two to nine (mean: three) treatment sessions were re quired to obtain satisfactory reopening of major biliary strictures, E ight patients showed considerable and sustained improvement, The mean serum bilirubin, alkaline phosphatase, gamma-glutamyl-transpeptidase, and alanine aminotransferase levels fell significantly by 73% (P = 0.0 164), 46% (P = 0.0022), 55% (P = 0.0022), and 58% (P = 0.0022), respec tively, The average radiographic stricture score before treatment was 3.2 +/- 0.7 (mean +/- SD), and after treatment decreased to 1.9 +/- 0. 8 (P = 0.0033), Three patients required liver transplantation seven, 1 2, and 40 months after the initiation of endoscopic treatment, due to a deterioration in hepatic function or an inability to exclude complex biliary malignancy, No major procedure-related side effects were obse rved, Conclusions: Our results suggest that the endoscopic treatment o f PSC patients with dominant bile duct strictures is effective, safe, and well-tolerated. However, it is important not to overlook the poten tial development of cholangiocarcinoma.