Subscribe to RSS
DOI: 10.1055/s-2003-40548
Self-expandable Metal Mesh Stents for Common Bile Duct Stenosis in Chronic Pancreatitis: Retrospective Evaluation of Long-term Follow-up and Clinical Outcome of a Pilot Study
Langzeitergebnisse der Therapie mit selbstexpandierenden Metallstents bei Patienten mit chronischer Pankreatitis und symptomatischer distaler Gallengangstenose: Retrospektive Ergebnisse einer PilotstudiePublication History
Manuscript received: 27. January 2003
Accepted after revision: 31. March 2003
Publication Date:
14 July 2003 (online)

Zusammenfassung
Hintergrund: Eine symptomatische distale Choledochusstenose tritt bei 10-30 % aller Patienten mit chronischer Pankreatitis auf. Patienten mit Komorbiditäten und Kontraindikationen gegen eine Operation bedürfen der endoskopischen Langzeittherapie, meist mit Plastikprothesen. Der Stellenwert von Metallstents als mögliche Alternative zu Plastikprothesen bei benignen distalen Gallengangstenosen ist noch ungeklärt. Methodik: Bei 6 Patienten mit chronischer Pankreatitis und symptomatischer distaler Choledochusstenose wurde ein selbstexpandierender Metallstent (Wallstent®) implantiert. Alle Patienten waren primär erfolglos mit Plastikprothesen behandelt und nachfolgend als inoperabel eingestuft worden. Ergebnisse: Die initiale Therapie mit Plastikprothesen wurde im Median 14 Monate durchgeführt. Der Wallstent konnte bei allen Patienten erfolgreich implantiert werden und der Nachbeobachtungszeitraum lag bei 58 Monaten. Die mediane Offenheitsrate der Wallstents betrug 20 Monate. Im Langzeitverlauf profitierten 2/6 Patienten von der Therapie mit einem Wallstent, bei 4/6 Patienten wurden endoskopische Sekundärmaßnahmen notwendig. Schlussfolgerungen: Für eine Untergruppe von Patienten mit symptomatischer distaler Choledochusstenose und Versagen der endoskopischen Therapie mit Plastikprothesen kann die Einlage eines selbstexpandierenden Metallstents eine sichere und effektive Drainagemaßnahme bedeuten. Aufgrund der begrenzten Patientenzahl und des inhomogenen Patientengutes muss der Erfolg dieser Therapie im Langzeitverlauf in größeren Studien untersucht werden.
Abstract
Background: Symptomatic common bile duct strictures are frequently seen in the course of severe chronic pancreatitis with a reported incidence of 10-30 %. The exact role of endoscopic stenting with metal prostheses as definitive treatment has not yet been clearly defined. Methods: Six patients with symptomatic distal common bile duct stricture in the setting of chronic pancreatitis were treated with a self-expandable metal stent in an attempt to achieve permanent drainage. All cases were approached non-operatively and underwent prior unsuccessful treatment with plastic prostheses. Results: The patients received a self-expandable metal Wallstent® after a median follow-up of 14 months of plastic stenting. The median follow-up time was 58 months and the stents remained open for a median time of 20 months, respectively. Overall, in 2 of 6 cases the metal stent therapy was successful while 4 of 6 patients required additional endoscopic procedures. Conclusions: Self-expandable metal stents could be useful and adequate in patients who suffer from symptomatic obstructive jaundice due to chronic pancreatitis. However, they provide acceptable dilation of the common bile duct for only a limited period of time. Overall, endoscopic stenting with self-expandable metal stents seems to be an advantageous treatment only for a subgroup of patients who are unfavorable candidates for surgical drainage. To clarify the role of the endoscopic approach, prospective trials with homogenous and larger patient numbers are necessarily in the future.
Schlüsselwörter
chronische Pankreatitis - benigne Gallengangstenose - endoskopische Stenttherapie - selbstexpandierender Metallstent
Key words
Chronic pancreatitis - benign bile duct stricture - endoscopic stenting - self expandable metal mesh stent
References
- 1
Jakobs R, Riemann J F.
The role of endoscopy in acute recurrent and chronic pancreatitis and pancreatic cancer.
Gastroenterology Clinics of North America.
1999;
28
783-800
MissingFormLabel
- 2
Smith M T, Sherman S, Lehman G A.
Endoscopic management of benign strictures of the biliary tree.
Endoscopy.
1995;
27
253-266
MissingFormLabel
- 3
Ng C, Huibregtse K.
The role of endoscopic therapy in chronic pancreatitis-induced common biled duct strictures.
Gastrointestinal Endoscopy Clinics of North America.
1998;
8
181-193
MissingFormLabel
- 4
Schlosser W, Siech M, Görich J. et al .
Common bile duct stenosis in complicated chronic pancreatitis.
Scand J Gastroenterol.
2001;
2
214-219
MissingFormLabel
- 5
Kamal M FI, Taylor T V.
The challenge of therapy for pancreatitis-related common bile duct stricture.
Am J Surg.
1995;
170
543-546
MissingFormLabel
- 6
Stahl T J, Allen M O, Ansel H J. et al .
Partial biliary obstruction caused by chronic pancreatitis. An appraisal of indications
for surgical biliary drainage.
Ann Surg.
1988;
207
26-32
MissingFormLabel
- 7
Deviere J, Devaere S, Baize M. et al .
Endoscopic biliary drainage in chronic pancreatitis.
Gastrointest Endosc.
1990;
36
96-100
MissingFormLabel
- 8
Smits M E, Rauws E AJ, van Gulik T M. et al .
Long-term results of endoscopic stenting and surgical drainage for biliary stricture
due to chronic pancreatitis.
British Journal of Surgery.
1996;
83
764-768
MissingFormLabel
- 9
Vitale G C, Reed D N, Nguyen C T. et al .
Endoscopic treatment of distal bile duct stricture from chronic pancreatitis.
Surg Endosc.
2000;
14
227-231
MissingFormLabel
- 10
Farnbacher M J, Rabenstein T, Ell C. et al .
Is endoscopic drainage of common bile duct stenoses in chronic pancreatitis Up-to-Date?.
Am J Gastroenterol.
2000;
95
1466-1471
MissingFormLabel
- 11
Eickhoff A, Jakobs R, Leonhardt A. et al .
Endoscopic stenting for common bile duct stenoses in chronic pancreatitis: results
and impact on long-term outcome.
Eur J Gastroenterol Hepatol.
2001;
13
1161-1167
MissingFormLabel
- 12
Deviere J, Cremer M, Baize M. et al .
Management of common bile duct stricture caused by chronic pancreatitis with metal
mesh self-expandable stents.
Gut.
1994;
35
122-126
MissingFormLabel
- 13
Westerloo D J Van, Bruno M J, Bergman J J. et al .
Self expandable Wallstents for distal common bile duct strictures in chronic pancreatitis:
Follow-up and clinical outcome of 15 patients.
Gastroenterology.
2000;
A-913
4693
MissingFormLabel
- 14
Draganov P, Hoffmann B, Marsh W. et al .
Long-term outcome in patients with benign biliary strictures treated endoscopically
with multiple stents.
Gastrointest Endosc.
2002;
55
680-686
MissingFormLabel
- 15
Born P, Rosch T, Bruhl K. et al .
Long-term results of endoscopic treatment of biliary duct obstruction due to pancreatic
disease.
Hepatogastroenterology.
1998;
45
833-839
MissingFormLabel
- 16
Kiehne K, Fölsch U R, Nitsche R.
High complication rate of bile duct stents in patients with chronic alcoholic pancreatitis
due to noncompliance.
Endoscopy.
2000;
32
377-380
MissingFormLabel
- 17
Davids P H, Groen A K, Rauws E AJ. et al .
Randomized trial of self-expanding metal stents versus polyethylene stents of distal
malignant biliary obstruction.
Lancet.
1992;
340
488-492
MissingFormLabel
- 18
Prat F, Chapat O, Ducot B. et al .
A randomized trial of endoscopic drainage methods for inoperable malignant strictures
of the common bile duct.
Gastrointest Endosc.
1998;
47
1-7
MissingFormLabel
- 19
Hoepffner N, Foerster E C, Hogemann B. et al .
Long-term experience in Wallstent therapy for malignant choledochal stenosis.
Endoscopy.
1994;
26
597-602
MissingFormLabel
- 20
Huibregtse K, Carr-Locke D L, Cremer M. et al .
Biliary stent occlusion: a problem solved with self-expanding metal stents? European
Wallstent Study Group.
Endoscopy.
1992;
24
391-394
MissingFormLabel
- 21
Schofl R, Brownstone E, Reichel W. et al .
Malignant bile-duct obstruction: experience with self-expanding metal endoprostheses
(Wallstents) in Austria.
Endoscopy.
1994;
26
592-596
MissingFormLabel
- 22
Dumonceau J M, Deviere J, Delhaye M. et al .
Plastic and metal stents for postoperative biliary strictures.
Gastrointest Endosc.
1998;
47
8-17
MissingFormLabel
- 23
Gabelmann A, Hamid H, Brambs H J. et al .
Metallic stents in benign biliary strictures: long-term effectiveness and interventional
management of stent occlusion.
Am J Roentgenol.
2001;
177
813-817
MissingFormLabel
- 24
Hausegger K A, Kugler C, Uggowitzer M. et al .
Benign biliary obstruction: is treatment with the Wallstent advisable?.
Radiology.
1996;
200
437-441
MissingFormLabel
- 25
Dumonceau J M, Nicaise N, Deviere J.
The ultraflex diamond stent for benign biliary obstruction.
Gastrointest Endosc Clin N Am.
1999;
9
541-545
MissingFormLabel
- 26
O’Brien S M, Hatfield A R, Craig P I. et al .
A 5-year follow-up of self-expanding metal stents in the endoscopic management of
patients with benign bile duct strictures.
Eur J Gastroenterol Hepatol.
1998;
10
141-145
MissingFormLabel
- 27
Menon K, Romagnuolo J, Barkun A N.
Expandable metal biliary stenting in patients with recurrent premature polyethylene
stent occlusion.
Am J Gastroenterol.
2001;
96
1435-1440
MissingFormLabel
- 28
Hastier P, Buckley M JP, Peten E P. et al .
Long term treatment of biliary stricture due to chronic pancreatitis with a metallic
stent.
Am J Gastroenterol.
1999;
94
1947-1948
MissingFormLabel
- 29
Kahl S, Zimmermann S, Glasbrenner B. et al .
Treatment of benign biliary strictures in chronic pancreatitis by self-expandable
metal stents.
Dig Dis.
2002;
20
199-203
MissingFormLabel
- 30
Isayama H, Komatsu Y, Tsujino T. et al .
Polyurethane-covered metal stent for management of distal malignant biliary obstruction.
Gastrointest Endosc.
2002;
55
366-370
MissingFormLabel
- 31
Schutz S M, Baillie J.
Another treatment option for biliary strictures from chronic pancreatitis.
Am J Gastroenterol.
1995;
601023-601024
MissingFormLabel
Dr. med. Axel Eickhoff
Medical Department C,
Klinikum Ludwigshafen
Bremserstr. 79
D-67063 Ludwigshafen
Email: MedCLu@t-online.de