Common Bile Duct Strictures Due to Chronic Pancreatitis Managed by Self-Expandable-Metal Stents (SEMS): Results of a Long-Term Follow-Up Study

Abstract

Background: Common bile duct (CBD) strictures are a common complication of chronic pancreatitis (CP). Successful dilation of these strictures by insertion of an increasing number of plastic stents is not effective as in the setting of postoperative bile duct stenoses. Aim: To evaluate long-term results of the management of CP-related CBD strictures by SEMS. Methods: From 1990 to 2002, 24 patients (21 M, mean age 48 yrs) with a symptomatic CP-related CBD stricture refractory to plastic stenting that refused surgery, were treated by placement of a biliary SEMS at our institution. Seven (29%) patients had pancreatic calcifications. All patients had a minimum follow-up of 2 years, and SEMS patency was assessed. Results: Eighteen (75%) uncovered SEMS were inserted. Eight (33%) patients still had a functioning SEMS after a mean period of 52 months (range 26-121). Sixteen (66%) patients developed a SEMS malfunction after a mean period of 39 months (range 5-103). Follow-up of patent covered SEMS was 35 months (range 33-37) while that for uncovered SEMS was 61 months (range 26-121). Patency of clogged SEMS according to stent features is summarized in the Table. Conclusions: Placement of SEMS in CBD strictures secondary to CP could be a valid alternative to surgery. Covered stents were placed only during recent years and longer follow-up is necessary to compare covered and uncovered SEMS in this kind of biliary stenoses.