Endoscopic stenting for common bile duct stenoses in chronic pancreatitis:results and impact on long-term outcome

Objectives The overall incidence of common bile duct strictures due to chro nic pancreatitis is reported to be approximately 10-30%. It remains a chall enging problem for gastroenterologists and surgeons. The exact role of endo scopic stenting has not yet been clearly defined. Design and methods Thirty-nine patients with chronic pancreatitis and sympt omatic common bile duct stenoses underwent endoscopic stenting and were stu died retrospectively. We were particularly interested in how many patients would achieve resolution of the stricture and tolerate removal of the stent s in the long term. Results Indications for endoscopic stenting were symptomatic cholestasis, j aundice or cholangitis. The initial serum bilirubin was 8.3 mg/dl and the d iameter of the common bile duct was 14.2 mm before stenting. Within 3-7 day s of stenting, all patients presented improvement of jaundice and cholestas is. After a median stenting time of 9 months (range 1-144 months), 46% of t he patients demonstrated regression of the stricture and clinical improveme nt, 26% required further stenting, and 28% were referred to surgery. Five p atients received a self-expandable metal Wallstent Thirty-one per cent demo nstrated complete clinical recovery of the stricture as well as 10.2% a com plete, radiologically verified stricture regression in a median follow-up o f 58 months, Conclusions There seems to be a therapeutic benefit for short-term endoscop ic treatment but medium-term and long-term outcome remains questionable. En doscopic stenting should be applied as an initial therapy before surgery, b ut it can be the definitive approach for older and morbid patients or cases with complete stricture regression after stent removal. Overall, it should not be considered as a routine procedure for symptomatic cases. Eur J Gast roenterol Hepatol 13:1161-1167 (C) 2001 Lippincott Williams & Wilkins.