Download PDF
Endoscopy 1999; 31(9): 725-731
DOI: 10.1055/s-1999-152
Original Article
Georg Thieme Verlag Stuttgart · New York

Long-Term Results of Endoscopic and Percutaneous Transhepatic Treatment of Benign Biliary Strictures

P. Born, T. Rösch, K. Brühl, W. Sandschin, H.-D. Allescher, E. Frimberger, M. Classen
  • Dept. of Internal Medicine II, Technical University of Munich, Munich, Germany
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: Benign biliary strictures, mostly associated with biliary surgery, are of growing importance for the therapeutic endoscopist. In the short term, endoscopic therapy has success rates similar to those of surgery. With regard to the long-term results, fewer data are available, particularly concerning forms of treatment including percutaneous transhepatic biliary drainage (PTBD) as an additional tool. The present study was aimed at allowing evaluation of the short and long-term results of endoscopic and percutaneous treatment in patients with benign biliary strictures.

Patients and Methods: The charts of 40 consecutive patients treated during the period 1992 - 1994 (12 men, 28 women; median age 60.5 years, range 24 - 86) were analyzed retrospectively. Long-term follow-up was carried out by direct contact. In almost all of the cases, the endoscopic treatment consisted of papillotomy and stenting (single stent treatment 10 or 11.5 Fr); Yamakawa-type prostheses (14 or 16 Fr) were used in the PTBD patients.

Results: The primary treatment was successful in 37 of the 40 patients, including nine of 21 patients (43 %) treated endoscopically and 28 of 31 patients (90 %)treated using the percutaneous approach. The complication rates after endoscopic retrograde cholangiopancreatography (ERCP) were 14 %, compared with 26 % after PTBD. Relief of the stricture was achieved in 25 patients after a median period of stent treatment of nine months (range 3 - 44), while recurrences were seen in six patients with stents in place for only 4.5 months (range 1 - 8), and in one patient with a metal stent. Therapy failed in two patients, and three were lost to follow-up. Serious long-term complications were rare, but there was a fatal complication in one patient with metal stents. The follow-up period was 44 months (range 11 - 66). Three patients underwent successful primary surgery, and three more underwent successful surgery after stricture recurrence; all were free of complaints after 49 months (range 40 - 44).

Conclusions: Endoscopic and percutaneous treatment of benign biliary strictures is not only a short-term treatment, but also an adequate long-term therapeutic alternative to surgery, with tolerable complication rates. The period of stenting appears to influence the outcome, and the diameter of the stents used also probably plays a role. Prospective studies are required for further evaluation of these observations.

References

  • 1 McDonald ML, Farnell MB, Nagorney DM, et al. Benign biliary strictures: repair and outcome with a contemporary approach.  Surgery. 1995;  118 582-591
    PubMedGoogle Scholar
  • 2 Smith MT, Sherman S, Lehman GA. Endoscopic management of benign strictures of the biliary tree.  Endoscopy. 1995;  27 253-266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Siewert JR, Feussner H, Scherer MA, Brune IB. Fehler und Gefahren der laparoskopischen Cholecystektomie.  Chirurg. 1993;  64 221-229
    PubMedGoogle Scholar
  • 4 Koivusalo A, Isoniemi H, Salmela K, et al. Biliary complications in one hundred adult liver transplantations.  Scand J Gastroenterol. 1996;  31 506-511
    PubMedGoogle Scholar
  • 5 Rizk RS, McVicar JP, Emond MJ, et al. Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival.  Gastrointest Endosc. 1998;  47 128-135
    CrossrefPubMedGoogle Scholar
  • 6 Prat F, Pelletier G, Ponchon T, et al. What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy?.  Endoscopy. 1997;  29 341-348
    Google Scholar
  • 7 Davidoff AM, Pappas TN, Murray EA, et al. Mechanisms of major biliary injury during laparoscopic cholecystectomy.  Ann Surg. 1992;  215 196-202
    CrossrefPubMedGoogle Scholar
  • 8 Williams LF Jr, Chapman WC, Bonau RA, et al. Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center.  Am J Surg. 1993;  165 459-465
    PubMedGoogle Scholar
  • 9 Adamsen S, Hansen OH, Funch-Jensen P, et al. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series.  J Am Coll Surg. 1997;  184 571-578
    PubMedGoogle Scholar
  • 10 Pellegrini CA, Thomas MJ, Way LW. Recurrent biliary stricture.  Am J Surg. 1984;  147 175-180
    CrossrefPubMedGoogle Scholar
  • 11 Huibregtse K, Katon RM, Tytgat GNJ. Endoscopic treatment of postoperative biliary strictures.  Endoscopy. 1986;  18 133-137
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Krömer MU, Maier M, Benz CA, et al. Gallengangsstenosen und -lecks nach Cholecystektomie: Endoskopische Diagnostik, Therapie und Behandlungserfolg.  Z Gastroenterol. 1996;  34 167-172
    PubMedGoogle Scholar
  • 13 Raute M, Schaupp W. Iatrogene Schäden an den Gallenwegen infolge Cholecystektomie.  Langenbecks Arch Chir. 1988;  373 345-354
    PubMedGoogle Scholar
  • 14 Tocchi A, Costa G, Lepre L, et al. The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures.  Ann Surg. 1996;  224 162-167
    CrossrefPubMedGoogle Scholar
  • 15 Csendes A, Diaz C, Burdiles P, et al. Indications and results of hepaticojejunostomy in benign strictures of the biliary tract.  Hepato-Gastroenterology. 1992;  39 333-336
    PubMedGoogle Scholar
  • 16 Wahab MA, El-Ebiedy G, Sultan A, et al. Postcholecystectomy bile duct injuries: experience with 49 cases managed by different therapeutic modalities.  Hepato-Gastroenterology. 1996;  43 1141-1147
    PubMedGoogle Scholar
  • 17 Huibregtse K, Cheng J, Rauws EAJ, Tytgat GNJ. Postoperative biliary strictures: the endoscopic approach.  Scand J Gastroenterol. 1989;  24 (Suppl 171) 50-56
    PubMedGoogle Scholar
  • 18 Geenen DJ, Geenen JF, Hogan WJ, et al. Endoscopic therapy for benign bile duct strictures.  Gastrointest Endosc. 1989;  35 367-371
    PubMedGoogle Scholar
  • 19 Bergman JJGHM, van den Brink GR, Rauws EAJ, et al. Treatment of bile duct lesions after laparoscopic cholecystectomy.  Gut. 1996;  38 141-147
    CrossrefPubMedGoogle Scholar
  • 20 Van Sonnenberg E, Casola G, Wittich GR, et al. The role of interventional radiology for complications of cholecystectomy.  Surgery. 1990;  107 632-638
    PubMedGoogle Scholar
  • 21 Mueller PR, van Sonnenberg E, Ferrucci JT, et al. Biliary stricture dilatation: multicenter review of clinical management in 73 patients.  Radiology. 1986;  160 17-22
    CrossrefPubMedGoogle Scholar
  • 22 Molnar W, Stockum AE. Transhepatic dilatation of choledochoenterostomy strictures.  Radiology. 1978;  129 59-64
    CrossrefPubMedGoogle Scholar
  • 23 Trambert JJ, Bron KM, Zajko AB, et al. Percutaneous transhepatic balloon dilatation of benign biliary strictures.  AJR. 1987;  149 945-948
    PubMedGoogle Scholar
  • 24 Escourrou J, Berthelemy P. Biliäre Komplikationen nach laparoskopischer Cholecystektomie.  Dtsch Med Wochenschr. 1993;  118 1157-1162
    PubMedGoogle Scholar
  • 25 Vitale GC, George M, McIntyre K, et al. Endoscopic management of benign and malignant strictures.  Am J Surg. 1996;  171 553-557
    CrossrefPubMedGoogle Scholar
  • 26 Born P, Neuhaus H, Rösch T, et al. A minimally invasive palliative approach to advanced pancreatic and papillary cancer causing both biliary and duodenal obstruction.  Z Gastroenterol. 1996;  34 416-420
    PubMedGoogle Scholar
  • 27 Jeng KS. Treatment of intrahepatic biliary stricture associated with hepatolithiasis.  Hepato-Gastroenterology. 1997;  44 342-351
    PubMedGoogle Scholar
  • 28 Dumonceau JM, Devière J, Delhaye M, et al. Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst.  Gastrointest Endosc. 1998;  47 8-17
    CrossrefPubMedGoogle Scholar
  • 29 Gilbert DA, DiMarino AJ Jr, Jensen DM, et al. Status evaluation: biliary stents (American Society for Gastrointestinal Endoscopy, Technology Assessment Committee).  Gastrointest Endosc. 1992;  38 750-752
    PubMedGoogle Scholar
  • 30 Rossi P, Bezzi M, Salvatori FM, et al. Recurrent benign biliary strictures: management with self-expanding metallic stents.  Radiology. 1990;  175 661-665
    PubMedGoogle Scholar
  • 31 Hausegger KA, Kugler C, Uggowitzer M, et al. Benign biliary obstruction: is treatment with the Wallstent advisable?.  Radiology. 1996;  200 437-441
    PubMedGoogle Scholar
  • 32 Rossi RL, Asbun HJ, Martin RF, et al. Use of expandable metal stents for benign biliary strictures: need for balanced multidisciplinary approach.  Gastrointest Endosc. 1996;  43 73-75
    PubMedGoogle Scholar
  • 33 Lee MJ, Mueller PR, Saini S, et al. Percutaneous dilatation of benign biliary strictures: single-session therapy with general anesthesia.  AJR. 1991;  157 1263-1266
    PubMedGoogle Scholar
  • 34 Moore AV, Illescas FF, Mills SR, et al. Percutaneous dilation of benign biliary strictures.  Radiology. 1987;  163 625-628
    PubMedGoogle Scholar
  • 35 Davids PHP, Rauws EAJ, Coene PPLO, et al. Endoscopic stenting for postoperative biliary strictures.  Gastrointest Endosc. 1992;  38 12-18
    CrossrefPubMedGoogle Scholar
  • 36 Citron SJ, Martin LG. Benign biliary strictures: treatment with percutaneous cholangioplasty.  Radiology. 1991;  178 339-341
    PubMedGoogle Scholar
  • 37 Pitt HA, Kaufman SL, Coleman J, et al. Benign postoperative biliary strictures.  Ann Surg. 1989;  210 417-425
    CrossrefPubMedGoogle Scholar
  • 38 Nealon WH, Urrutia F. Long-term follow-up after bilioenteric anastomosis for benign bile duct stricture.  Ann Surg. 1996;  223 639-648
    CrossrefPubMedGoogle Scholar
  • 39 Pereira-Lima L. Biliary reconstruction in benign postoperative stricture with transhepatic tubes.  Am J Surg. 1992;  164 124-128
    PubMedGoogle Scholar
  • 40 Millis JM, Tompkins RK, Zinner MJ, et al. Management of bile duct strictures.  Arch Surg. 1992;  127 1077-1084
    PubMedGoogle Scholar
  • 41 Vogel SB, Howard RJ, Caridi J, Hawkins IF Jr. Evaluation of percutaneous transhepatic balloon dilatation of benign biliary strictures in high-risk patients.  Am J Surg. 1985;  149 73-79
    PubMedGoogle Scholar
  • 42 Blumgart LH, Kelley CJ, Benjamin IS. Benign bile duct stricture following cholecystectomy: critical factors in management.  Br J Surg. 1984;  71 836-843
    CrossrefPubMedGoogle Scholar

P. BornM.D. 

II. Medizinische Klinik

Klinikum rechts der Isar

Technische Universität München

Ismaningerstrasse 22

81675 München

Germany

Phone: + 49-89-4140-4905

      >