Sequential Endoscopic Management Of Postoperative Biliary Strictures: Short And Long-Term Results

Aims To evaluate short and long-term results of endoscopic treatment of postoperative biliary strictures (POBS).

Methods Retrospective follow-up single center study was held from January 1991 to October 2020. Endoscopic transpapillary interventions for POBS were performed in 89 patients (f-63/89-70.8 %, m-26/89-29.2 %), mean age 53.2±21,3 years (range 21–88). Total 412 procedures were performed. In anamnesis patients had cholecystectomy in 67(75.3 %), hemihepatectomy-6(8.7 %), EPT and stone extraction–4(4.5 %), liver transplantation–12(13.5 %) cases. The main manifestation of POBS was jaundice 82(92.1 %), including cholangitis/liver abscess - 29(32.6 %)pts. Common bile duct (CBD) stones were observed in 39(43.9 %)pts.

Intervention	N pts.(%)
EPT	6(6.7 %)
EPT+endoscopic bouginage (EB)	11(12.4 %)
EPT+EB+multiple endoscopic stenting	36(38.5 %)
EPT+EB+balloon dilation+multiple endoscopic stenting	32(36 %)

Results There were 4 lines of endoscopic treatment of POBS (Table).

Planned interventions were performed every 2-6 months. Median period of treatment lasted 18 months (range 12-28). Good immediate and short-term results (resolution of jaundice, cholangitis and initiation of staged endoscopic treatment) were obtained in 72/89 (80.9 %) pts. Another 9(10.1 %) pts. underwent EB, but complete drainage of CBD above POBS was unsuccessful, so planned surgery was performed. It wasn’t possible to pass above stricture and eliminate jaundice in 8(9 %) pts. (urgent surgical treatment – 7, death – 1). Complications occurred in 6(6.7 %) cases (bleeding - 2, postoperative pancreatitis - 2, perforation – 2). Five of them were successfully eliminated endoscopically, one (bleeding from EPT area) was operated on (lethal outcome), so mortality level was 1.1 % (1).

Long-term outcomes were investigated in 53/72(73.6 %) available for control patients. Mean follow-up time was 8.5 years (range 1-25). Good results were obtained in 47/53(88.7 %) patients; satisfactory (recurrent CBD stones) – in 4/53(7.5 %); poor (POBS relapse in 6 and 19 months after endoscopic treatment) in 2/53(3.8 %) patients.

Conclusions The first line management for POBS is sequential endoscopic treatment; immediate technical success of it was 80.9 % (72/89). Staged endoscopic treatment allows achieving good and satisfactory long-term results in 96.2 % (51/53) of patients who started staged treatment.

Citation Budzinskiy S, Shapovalianz S, M. Zakharova et al. eP335 SEQUENTIAL ENDOSCOPIC MANAGEMENT OF POSTOPERATIVE BILIARY STRICTURES: SHORT AND LONG-TERM RESULTS. Endoscopy 2021; 53: S207.

Publication History

Article published online:
19 March 2021