MANAGEMENT OF COMMON BILE-DUCT STRICTURE CAUSED BY CHRONIC-PANCREATITIS WITH METAL MESH SELF-EXPANDABLE STENTS

Twenty patients with chronic pancreatitis and signs of biliary obstruc tion were treated by endoscopic placement of self expandable metal mes h stents, and followed up prospectively. Eleven had been treated previ ously with plastic endoprostheses. All had persistent cholestasis, sev en patients had jaundice, and three overt cholangitis. Endoscopic sten t placement was successful in all cases. No early clinical complicatio n was seen and cholestasis, jaundice or cholangitis rapidly resolved i n all patients. Mean follow up was 33 months (range 24 to 42) and cons isted of clinical evaluation, ultrasonography, and endoscopic retrogra de cholangiopancreatography (ERCP). In 18 patients, successive ERCPs a nd cholangioscopies have shown that the metal mesh initially embeds in the bile duct wall and is rapidly covered by a continuous tissue by t hree months. The stent lumen remained patent and functional throughout the follow up period except in two patients who developed epithelial hyperplasia within the stent resulting in recurrent biliary obstructio n, three and six months after placement. They were treated endoscopica lly with standard plastic stents with one of these patients ultimately requiring surgical drainage. No patient free of clinical or radiologi cal signs of epithelial hyperplasia after six months developed obstruc tion later. This new treatment could become an effective alternative t o surgical biliary diversion if further controlled follow up studies c onfirm the initial impression that self expandable metal mesh stents o ffer a low morbidity alternative for longterm biliary drainage in chro nic pancreatitis without the inconvenience associated with plastic ste nts.