Endoscopic treatment of distal bile duct stricture from chronic pancreatitis

Background: Endoscopic placement of biliary stents is an effective initial treatment for jaundice and cholangitis caused by common bile duct (CBD) str ictures secondary to chronic pancreatitis; however, the role of endoscopic treatment for long-term management of these strictures is less clear. In 19 92, we designed a protocol of balloon dilatation and stenting for greater t han or equal to 12 months. This study evaluates endoscopic therapy as a def initive long-term treatment for these strictures. We have treated 25 patien ts with this protocol. Methods: All patients had an endoscopic sphincterotomy, balloon dilatation of the stricture, and then placement of a polyethylene stent (7-11.5 F). St ents were exchanged at 3-4-month intervals to avoid the complications of cl ogging and cholangitis. We were particularly interested in how many patient s would achieve resolution of the stricture and tolerate removal of the ste nt. Results: The length of the CBD strictures ranged from 8 to 40 mm. Within da ys of stenting, all patients achieved relief of jaundice and cholestasis. C omplications consisted of six episodes of cholangitis and nine episodes of pancreatitis. There were no deaths. Twenty of the 25 patients are now stent -free after an average stenting period of 13 months (range, 3-28). To date, there has been no recurrence of stricture, for a mean of 32 months. Three patients still have stents in place, and two patients required operation-on e for persistent stricture and recurrent cholangitis after 8 months of sten ting, and one for a mass in the head of the pancreas that was thought to be cancer. Conclusions: Our results indicate that these strictures will respond and di late after a course of stenting in 80% of patients, with an acceptable morb idity. Although these are medium-term results at 32 months, we would expect mast recurrences within the Ist year following stent removal. In some case s, stenting is necessary for >12 months. Thus, the data suggest that endosc opic stenting provides definitive treatment in most patients with CBD stric ture due to chronic pancreatitis and may be considered a viable alternative to standard surgical bypass.