Long-term results of endoscopic and percutaneous transhepatic treatment ofbenign biliary strictures

Background and Study Aims: Benign biliary strictures, mostly associated wit h biliary surgery, are of growing importance for the therapeutic endoscopis t. In the short term, endoscopic therapy has success rates similar to those of surgery With regard to the long-term results, fewer data are available, particularly concerning forms of treatment including percutaneous transhep atic biliary drainage (PTBD) as an additional tool. The present study was a imed at allowing evaluation of the short and long-term results of endoscopi c and percutaneous treatment in patients with benign biliary strictures. Patients and Methods: The charts of 40 consecutive patients treated during the period 1992-1994 (12 men, 28 women; median age 60.5 years, range 24-86) were analyzed retrospectively. Long-term follow-up was carried out by dire ct contact. In almost all of the cases, the endoscopic treatment consisted of papillotomy and stenting (single stent treatment 10 or 11.5 Fr); Yamakaw a-type prostheses (14 or 16 Fr) were used in the PTBD patients. Results: The primary treatment was successful in 37 of the 40 patients, inc luding nine of 21 patients (43%) treated endoscopically and 28 of 31 patien ts (90%) treated using the percutaneous approach. The complication rates af ter endoscopic retrograde cholangiopancreatography (ERCP) were 14 %, compar ed with 26 % after PTBD. Relief of the stricture was achieved in 25 patient s after a median period of stent treatment of nine months (range 3-44), whi le recurrences were seen in six patients with stents in place for only 4.5 months (range 1-8), and in one patient with a metal stent. Therapy failed i n two patients, and three were lost to follow-up. Serious long-term complic ations were rare, but there was a fatal complication in one patient with me tal stents. The follow-up period was 44 months (range 11-66). Three patient s underwent successful primary surgery, and three more underwent successful surgery after stricture recurrence; all were free of complaints after 49 m onths (range 40-44). Conclusions: Endoscopic and percutaneous treatment of benign biliary strict ures is not only a short-term treatment, but also an adequate long-term the rapeutic alternative to surgery, with tolerable complication rates. The per iod of stenting appears to influence the outcome, and the diameter of the s tents used also probably plays a role. Prospective studies are required for further evaluation of these observations.