Treatment of post-cholecystectomy biliary strictures with fully-covered self-expanding metal stents – results after 5 years of follow-up
-
Published:2019-12
Issue:1
Volume:19
Page:
-
ISSN:1471-230X
-
Container-title:BMC Gastroenterology
-
language:en
-
Short-container-title:BMC Gastroenterol
Author:
Tringali AndreaORCID, , Reddy D. Nageshwar, Ponchon Thierry, Neuhaus Horst, Lladó Ferrán González-Huix, Navarrete Claudio, Bruno Marco J., Kortan Paul P., Lakhtakia Sundeep, Peetermans Joyce, Rousseau Matthew, Carr-Locke David, Devière Jacques, Costamagna Guido
Abstract
Abstract
Background
Endoscopic treatment of post-cholecystectomy biliary strictures (PCBS) with multiple plastic biliary stents placed sequentially is a minimally invasive alternative to surgery but requires multiple interventions. Temporary placement of a single fully-covered self-expanding metal stent (FCSEMS) may offer safe and effective treatment with fewer re-interventions. Long-term effectiveness of treatment with FCSEMS to obtain PCBS resolution has not yet been studied.
Methods
In this prospective multi-national study in patients with symptomatic benign biliary strictures (N = 187) due to various etiologies received a FCSEMS with scheduled removal at 6–12 months and were followed for 5 years. We report here long-term outcomes of the subgroup of patients with PCBS (N = 18). Kaplan Meier analyses assessed long-term freedom from re-stenting. Adverse events were documented.
Results
Endoscopic removal of the FCSEMS was achieved in 83.3% (15/18) of patients after median indwell of 10.9 (range 0.9–13.8) months. In the remaining 3 patients (16.7%), the FCSEMS spontaneously migrated and passed without complications. At the end of FCSEMS indwell, 72% (13/18) of patients had stricture resolution. At 5 years after FCSEMS removal, 84.6% (95% CI 65.0–100.0%) of patients who had stricture resolution at FCSEMS removal remained stent-free. In addition, at 75 months after FCSEMS placement, the probability of remaining stent-free was 61.1% (95% CI 38.6–83.6%) for all patients. Stent or removal related serious adverse events occurred in 38.9% (7/18) all resolved without sequalae.
Conclusions
In patients with symptomatic PCBS, temporary placement of a single FCSEMS intended for 10–12 months indwell is associated with long-term stricture resolution up to 5 years. Temporary placement of a single FCSEMS may be considered for patients with PCBS not involving the main hepatic confluence.
Trial registration numbers
NCT01014390; CTRI/2012/12/003166; Registered 17 November 2009.
Funder
Boston Scientific Corporation
Publisher
Springer Science and Business Media LLC
Subject
Gastroenterology,General Medicine
Reference22 articles.
1. Chandrasekhara V, Chathadi KV, Acosta RD, Decker GA, Early DS, Eloubeidi MA, Evans JA, Faulx AL, Fanelli RD, Fisher DA, Foley K, Fonkalsrud L, Hwang JH, Jue TL, Khashab MA, Lightdale JR, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Shaukat A, Shergill AK, Wang A, Cash BD, DeWitt JM, Committee, A. S. o. P. The role of endoscopy in benign pancreatic disease. Gastrointest Endosc. 2015;82(2):203–14. 2. Dumonceau JM, Tringali A, Papanikolaou IS, Blero D, Mangiavillano B, Schmidt A, Vanbiervliet G, Costamagna G, Devière J, García-Cano J, Gyökeres T, Hassan C, Prat F, Siersema PD, van Hooft JE. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline - updated October 2017. Endoscopy. 2018;50(9):910–30. 3. Fullum TM, Downing SR, Ortega G, Chang DC, Oyetunji TA, Van Kirk K, Tran DD, Woods I, Cornwell EE, Turner PL. Is laparoscopy a risk factor for bile duct injury during cholecystectomy? JSLS. 2013;17(3):365–70. 4. Fortunato AA, Gentile JK, Caetano DP, Gomes MA, Bassi MA. Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy. Arq Bras Cir Dig. 2014;27(4):272–4. 5. Pekolj J, Alvarez FA, Palavecino M, Sánchez Clariá R, Mazza O, de Santibañes E. Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg. 2013;216(5):894–901.
Cited by
21 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|