BACKGROUND: Endoscopic dilation of postoperative biliary strictures with increasing numbers of stents was first described by our group in 2001 with promising results after a long-term follow-up (mean 4 years). OBJECTIVE: To verify results of endoscopic treatment of postoperative biliary strictures at a very-long-term follow-up. DESIGN: Single center, follow-up study. SETTING: Tertiary-care, academic referral center. PATIENTS: A group of 42 patients from our 2001 study, who had undergone endoscopic dilation of postoperative biliary strictures with the multiple endoscopic stenting technique, underwent systematic follow-up. The last telephone follow-up was done in September 2009. INTERVENTION: Clinical conditions and the occurrence of new biliary symptoms during the follow-up period were assessed, and results of the most recent liver function tests and abdominal US were recovered. MAIN OUTCOME MEASUREMENTS: Occurrence of cholangitis and liver function test evaluation during the follow-up period. RESULTS: Of the 40 patients who were alive at the end of the study published in 2001, 5 (12.5%) died of unrelated causes after a mean of 6.7 years (range 3-13.3 years) from the end of treatment, without further biliary symptoms. The overall mean follow-up time for the remaining 35 patients (87.5%) was 13.7 years (range 11.7-19.8 years). Seven patients (20%) experienced recurrent acute cholangitis after a mean of 6.8 years (range 3.1-11.7 years) from the end of treatment. All 7 of these patients underwent ERCP. Four of the 7 patients had postoperative biliary stricture recurrence (n = 4/35, 11.4%) that was retreated endoscopically with placement of stents, and the other 3 patients had common bile duct stones (n = 3/35, 8.6%) that were extracted. No stricture or bile duct stone recurrences after retreatment were recorded after a mean follow-up period of a further 7.1 years (range 2.5-12.1 years). Twenty-eight patients remained asymptomatic with normal liver function test results and abdominal US results after a mean follow-up period of 13.7 years (range 11.7-19.8 years). LIMITATIONS: Telephone follow-up. CONCLUSION: Results of multiple endoscopic stenting for postoperative biliary strictures remain excellent even after a very-long-term follow-up. The stricture recurrence rate is low, and recurrences can be retreated endoscopically

Tringali, A., Costamagna, G., Mutignani, M., Perri, V., Spada, C., Pandolfi, M., Galasso, D., Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up., <<GASTROINTESTINAL ENDOSCOPY>>, 2010; 72 (Marzo): 551-557 [http://hdl.handle.net/10807/43352]

Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up.

Tringali, Andrea;Costamagna, Guido;Mutignani, Massimiliano;Perri, Vincenzo;Spada, Cristiano;Galasso, Domenico
2010

Abstract

BACKGROUND: Endoscopic dilation of postoperative biliary strictures with increasing numbers of stents was first described by our group in 2001 with promising results after a long-term follow-up (mean 4 years). OBJECTIVE: To verify results of endoscopic treatment of postoperative biliary strictures at a very-long-term follow-up. DESIGN: Single center, follow-up study. SETTING: Tertiary-care, academic referral center. PATIENTS: A group of 42 patients from our 2001 study, who had undergone endoscopic dilation of postoperative biliary strictures with the multiple endoscopic stenting technique, underwent systematic follow-up. The last telephone follow-up was done in September 2009. INTERVENTION: Clinical conditions and the occurrence of new biliary symptoms during the follow-up period were assessed, and results of the most recent liver function tests and abdominal US were recovered. MAIN OUTCOME MEASUREMENTS: Occurrence of cholangitis and liver function test evaluation during the follow-up period. RESULTS: Of the 40 patients who were alive at the end of the study published in 2001, 5 (12.5%) died of unrelated causes after a mean of 6.7 years (range 3-13.3 years) from the end of treatment, without further biliary symptoms. The overall mean follow-up time for the remaining 35 patients (87.5%) was 13.7 years (range 11.7-19.8 years). Seven patients (20%) experienced recurrent acute cholangitis after a mean of 6.8 years (range 3.1-11.7 years) from the end of treatment. All 7 of these patients underwent ERCP. Four of the 7 patients had postoperative biliary stricture recurrence (n = 4/35, 11.4%) that was retreated endoscopically with placement of stents, and the other 3 patients had common bile duct stones (n = 3/35, 8.6%) that were extracted. No stricture or bile duct stone recurrences after retreatment were recorded after a mean follow-up period of a further 7.1 years (range 2.5-12.1 years). Twenty-eight patients remained asymptomatic with normal liver function test results and abdominal US results after a mean follow-up period of 13.7 years (range 11.7-19.8 years). LIMITATIONS: Telephone follow-up. CONCLUSION: Results of multiple endoscopic stenting for postoperative biliary strictures remain excellent even after a very-long-term follow-up. The stricture recurrence rate is low, and recurrences can be retreated endoscopically
Inglese
Tringali, A., Costamagna, G., Mutignani, M., Perri, V., Spada, C., Pandolfi, M., Galasso, D., Endotherapy of postoperative biliary strictures with multiple stents: results after more than 10 years of follow-up., <<GASTROINTESTINAL ENDOSCOPY>>, 2010; 72 (Marzo): 551-557 [http://hdl.handle.net/10807/43352]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/43352
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