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

• Published in: Gastrointestinal endoscopy Vol. 54; no. 2; pp. 154 - 161
• Main Authors: Bergman, Jacques J.G.H.M., Burgemeister, Lotje, Bruno, Marco J., Rauws, Erik A.J., Gouma, Dirk J., Tytgat, Guido N.J., Huibregtse, Kees
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2001; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis - etiology; Cholecystectomy; Cholestasis, Extrahepatic - diagnostic imaging; Cholestasis, Extrahepatic - therapy; Diseases of the digestive system; Female; Follow-Up Studies; Humans; Jaundice - etiology; Male; Medical sciences; Middle Aged; Postoperative Complications - therapy; Prosthesis Implantation - mortality; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Retrospective Studies; Stents; Surveys and Questionnaires; Human; Postoperative; Biliary tract; Cholangiopancreatography; Radiodiagnosis; Retrograde; Instrumentation therapy; Stenosis; Biliary tract disease; Stent; Follow up study; Digestive diseases; Surgical approach; Feasibility; Endoscopy; Technique
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/mge.2001.116455

Background: The outcome of temporary biliary stent placement for postoperative bile duct stenosis was retrospectively evaluated with the main aim of assessing long-term complications after stent removal. Methods: ERCP was performed between 1981 and 1991 in 74 patients with postoperative 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 patients (19%) including 2 deaths. Therefore 57 patients were included in the stent phase of the study. In 10 patients the referring physician did not adhere to the treatment protocol, and nonelective stent exchange for jaundice and/or cholangitis was necessary in 7 (70%). Of the 47 patients treated according to protocol, complications developed in 40% during the period with stents in situ. Stents were eventually removed in 44 patients who were subsequently 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 undergo an ERCP for postoperative bile duct stenosis. After stent insertion and during the time with stents in situ, complications occur at a significant rate but are usually mild or reflect the patient's underlying condition. After stent removal, recurrent stenosis develops in 20% of patients within 2 years of stent removal. Endoscopic treatment should be the initial management of choice for postoperative bile duct stenosis. (Gastrointest Endosc 2001;54:154-61.)