Management of benign biliary strictures - Biliary enteric anastomosis vs endoscopic stenting

Hypothesis: Although advances in endoscopic procedures have provided altern ative options for relieving biliary obstructions, the overall chance of cur e for patients with benign biliary stricture is the same using surgical or endoscopic treatment. Design: Case-control study. Setting: Tertiary care university hospital. Patients: Of 163 patients referred for treatment with diagnoses of benign s trictures of the common bile duct between January 1, 1975, and July 1, 1998 , we studied 42 patients with postcholecystectomy stricture and a follow-up longer than 60 months. Twenty of these patients were treated with endoscop ic stenting and 22 with surgery (hepaticojejunostomy, choledochojejunostomy , or intrahepatic cholangiojejunostomy). Main Outcome Measures: Postoperative mortality and morbility and long-term outcome. The rate of restenosis was also determined. Results: Morbidity occurred more frequently in patients treated with endosc opic procedures than with surgical ones (9 vs 2; P = .34). Hospital mortali ty was 0%. Surgery achieved excellent or good long-term outcome in 17 of 22 patients. Endoscopic biliary stenting was successful in 16 of 20 patients. Overall, excellent or good outcomes were achieved in 34 patients (81%). Conclusion: The ability to achieve steady, long-term results confirms hepat icojejunostomy as the best procedure in the treatment of benign biliary str ictures, even if endoscopic procedures are gaining a new role in the treatm ent of a greater number of patients.