Long-term follow-up after biliary stent placement for postcholecystectomy bile duct strictures: a multicenter study

Background and study aims: Endoscopic stenting is a recognized treatment of postcholecystectomy biliary strictures. Large multicenter reports of its long-term efficacy are lacking. Our aim was to analyze the long-term outcomes after stenting in this patient population, based on a large experience from several centers in France.

Methods: Members of the French Society of Digestive Endoscopy were asked to identify patients treated for a common bile duct postcholecystectomy stricture. Patients with successful stenting and follow-up after removal of stent(s) were subsequently included and analyzed. Main outcome measures were long-term success of endoscopic stenting and related predictors for recurrence (after one stenting period) or failure (at the end of follow-up).

Results: A total of 96 patients were eligible for inclusion. The mean number of stents inserted at the same time was 1.9 ± 0.89 (range1 – 4). Stent-related morbidity was 22.9 % (n = 22). The median duration of stenting was 12 months (range 2 – 96 months). After a mean follow-up of 6.4 ± 3.8 years (range 0 – 20.3 years) the overall success rate was 66.7 % (n = 64) after one period of stenting and 82.3 % (n = 79) after additional treatments. The mean time to recurrence was 19.7 ± 36.6 months. The most significant independent predictor of both recurrence and failure was a pathological cholangiography at the time of stent removal.

Conclusion: Endoscopic stenting helps to avoid surgery in more than 80 % of patients bearing postcholecystectomy common bile duct strictures. However, a persistent anomaly on cholangiography at the time of stent removal is a strong predictor of recurrence and may lead to consideration of surgery.

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