Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents

Background. Endoscopic dilation with stents has been proposed as an alterna tive to hepaticojejunostomy for management of postoperative biliary strictu res. Good long-term results with double 10F plastic stent insertion for 1 y ear have been reported in 74% to 90% of cases. This is a review of our expe rience with a more aggressive approach. Methods: The technique, short-term results, and long-term results of placem ent of increasing numbers of stents until complete disappearance of the bil iary stricture are reported. At each exchange, the maximum possible number of stents in relation to the tightness of the stricture and diameter of the bile duct were inserted. All stents were removed at the end of treatment. Results: The records of 45 of 55 patients with postoperative biliary strict ures treated in this manner and observed consecutively were reviewed retros pectively. By intention-to-treat analysis the success rate was 89% (40/45). Early complications developed in 4 (9%) patients (3 cholangitis, 1 pancrea titis) and stent occlusion that required early exchange occurred in 8 (18%) patients. There was 1 death caused by a stroke 2 months after a stent exch ange. Forty-two patients completed the protocol (mean number of stents 3.2 +/-1.3; range 1-6). Mean duration of treatment was 12.1 +/-5.3 months (rang e 2-24 months). Two patients died of unrelated causes during follow-up. Amo ng the remaining 40 patients there was no recurrence of symptoms caused by relapsing biliary stricture at a mean follow-up of 48.8 months (range 2-11. 3 years). One patient sustained 2 episodes of cholangitis but without stric ture recurrence. Conclusions: This more aggressive approach to endoscopic treatment with ste nts may improve longterm results for patients with postoperative biliary st rictures.