Balloon dilation compared to stenting of dominant strictures in primary sclerosing cholangitis

OBJECTIVE:In some patients with primary sclerosing cholangitis (PSC), a loc alized, high-grade (dominant) stricture may be the principal cause of sympt oms and hyperbilirubinemia. The aim of this retrospective study was to comp are the beneficial effects and risk of balloon dilation alone versus dilati on followed by stenting in PSC patients with dominant strictures. METHODS: Charts from a group of 1009 patients with PSC seen over 10 yr were reviewed to identify those patients who had undergone endoscopic or percut aneous therapeutic intervention. Procedural and clinical data were recorded . RESULTS: A total of 71 PSC patients, median age of 49 yr (range 18-78 yr) w ere identified. Thirty-four patients were treated with endoscopic balloon d ilation alone, and 37 patients were treated with balloon dilation plus sten t placement. Stents were placed percutaneously (n = 19), endoscopically (n = 14), or using both interventions (n = 4). Both groups were comparable at baseline with regards to age, symptoms, and bilirubin level. The median dur ation of follow-up after intervention was similar in both groups. The numbe r of intervention-related complications (30 vs 6, p = 0.001) as well as the incidence of acute cholangitis (p = 0.004) were more common in the stent g roup compared to the balloon dilation group. There were more complications related to percutaneous stent placement than endoscopic placement (23 vs 7, p = 0.001). There was no significant difference between the two groups wit h regards to improving cholestasis. CONCLUSIONS: There was no additional obvious benefit from stenting after ba lloon dilation in the treatment of dominant strictures in PSC patients. Ste nting was associated with more complications, and its role after dilation s hould be assessed in a randomized trial rather than being accepted as routi nely indicated in this setting. (Am J Gastroenterol 2001;96:1059-1066. (C) 2001 by Am. Coll. of Gastroenterology).