Abstract
The success of balloon dilatation treatment of benign biliary strictures (BBS) is usually evaluated by 'clinical test'. For objective evaluation of treatment success, measurement of the pressure inside the biliary tree after treatment has been proposed. The aim of this article is to assess the role of biliary manometric perfusion test (BMPT) in the evaluation of treatment success of BBS and to assess the long term biliary patency after evaluation by BMPT. From February 2003 to January 2008, 12 patients (median age 53.5 years) after balloon dilatation treatment were evaluated by BMPT. BMPT was done after a mean of 3 dilatations over a mean period of 6.85 months. An intrabiliary pressure less than 20 cm of water during the test was considered as success threshold. The pressures during BMPT were less than 20 cm of water in 11 out of 12 patients. Subsequently the drain was removed and patients were followed up clinically. Two patients on follow-up required re-intervention 13 days and 11 months later. The remaining 9 patients had no evidence of biliary obstruction at a mean following of 15.3 months. Using the statistical Kaplan-Meier analysis, the probability of biliary patency up to 9 months was 90.9% and at 1, 2 and 3 years was 77%. BMPT is effective in the evaluation of treatment success of BBS. It is simple, cost effective, gives immediate results and helps us to determine the treatment end point.
Highlights
Benign biliary strictures are usually treated surgically or endoscopically
biliary manometric perfusion test (BMPT) is effective in the evaluation of treatment success of benign biliary strictures (BBS)
If the patients returned for control cholangiographies in view of dislocated drains, we assessed the strictures and if needed we proceeded with balloon dilatation of the stenosis during the same session
Summary
Benign biliary strictures are usually treated surgically or endoscopically. When surgical repair is impossible or endoscopic treatment is difficult, radiological percutaneous dilatation treatment is indicated. If the liver function tests are within the normal range, if the obstructive symptoms do not recur and bile leak from the percutaneous access is not seen, this suggests that the treated stricture will sustain prograde bile flow once the catheter is removed. If the liver function tests are elevated or if there are obstructive symptoms in the form of bile leak from the percutaneous access, another balloon dilatation and long term external internal drainage for another 3 months is done. For the objective evaluation of the treatment success, measurement of pressure inside the biliary tree (Biliary manometric perfusion test) has been proposed. We have earlier reported a case of biliary manometric perfusion test in a patient with benign biliary stricture and discussed the potential of the same in the treatment success evaluation[5]. The success of balloon dilatation treatment of benign biliary strictures (BBS) is usually evaluated by ‘clinical test’. For objective evaluation of treatment success, measurement of the pressure inside the biliary tree after treatment has been proposed
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