BILIARY MANOMETRY VERSUS CLINICAL-TRIAL - VALUE AS PREDICTORS OF SUCCESS AFTER TREATMENT OF BILIARY-TRACT STRUCTURES

PURPOSE: To evaluate the biliary manometric-perfusion test (BMPT) and clinical trial as predictors of long-term success after percutaneous a nd surgical treatment of biliary tract strictures. PATIENTS AND METHOD S: After percutaneous intervention or surgical repair of extrahepatic bile duct strictures, 43 patients underwent long-term biliary intubati on (mean, 13 months) with 61 internal-external stents. Before removal of the stents, all 43 patients underwent a BMPT (n = 65) and 24 underw ent a 2-3-week clinical trial (n = 27) with stents positioned above th e treated region. Patients were followed up 1-46 months (mean, 16 mont hs) after stent removal, with clinical outcome determined by means of physical examination, biochemical evaluation, chart review, and teleph one interview. RESULTS: With logistic regression analysis, the BMPT an d clinical trial were shown to have equal predictive value in determin ing treatment success or failure. Eighty-four percent of the clinical outcomes were correctly predicted with BMPT, versus 88% for the clinic al trial. Kaplan-Meier survival curve analysis demonstrated the probab ility of remaining stricture free at 1 year after passing a BMPT and a fter passing a clinical trial to be 90% and 86% (P = .55), respectivel y. CONCLUSION: BMPT and clinical trial have similar capabilities in th e prediction of long-term patency after treatment of benign biliary tr act strictures, but the BMPT is less costly and time consuming for the patient.