Long-term follow-up after biliary stent placement for postoperative bile duct stenosis

Background: The outcome of temporary biliary stent placement for postoperat ive bile duct stenosis was retrospectively evaluated with the main aim of a ssessing long-term complications after stent removal. Methods: ERCP was performed between 1981 and 1991 in 74 patients with posto perative bile duct stenoses. Two 10F stents were inserted for a maximum of 12 months with stent exchange every 3 months to avoid cholangitis caused by clogging. Results: Stent insertion failed in 11 patients with complete and 4 patients with incomplete biliary obstruction. Early complications occurred in 14 pa tients (19%) including 2 deaths. Therefore 57 patients were included in the stent phase of the study. In 10 patients the referring physician did not a dhere to the treatment protocol, and nonelective stent exchange for jaundic e and/or cholangitis was necessary in 7 (70%). Of the 47 patients treated a ccording to protocol, complications developed in 40% during the period with stents in situ. Stents were eventually removed in 44 patients who were sub sequently followed for a median of 9.1 years. Late complications developed in 15 patients (34%) including recurrent stenosis in 9 (20%). All cases of recurrent stenosis occurred within 2 years of stent removal. Conclusions: Endoscopic treatment is feasible in 80% of patients who underg o an ERCP for postoperative bile duct stenosis. After stent insertion and d uring the time with stents in situ, complications occur at a significant ra te but are usually mild or reflect the patient's underlying condition. Afte r stent removal, recurrent stenosis develops in 20% of patients within 2 ye ars of stent removal. Endoscopic treatment should be the initial management of choice for postoperative bile duct stenosis.