Long Term Plastic Stent Treatment for Benign Bile Duct Strictures: Not Always a “Benign” Course

Abstract

Introduction: Long-term treatment of benign bile duct strictures (BBDS) with polyethylene stents is undertaken in many pts who are not suitable candidates for surgery and have failed sequential balloon dilation and stent placement. The clinical course, complications, and outcome of long-term stent placement in this patient group have only recently been studied. Aim: We retrospectively analyzed the course of pts with BBDS treated long-term with ERCP and stent placement to determine the frequency and severity of complications, hospitalizations related to biliary disease, long-term outcome, and factors which may influence success of treatment. Methods: Pts with BBDS treated with polyethylene stents for >2 years were studied. All patients refused surgery, were poor candidates, or failed a course of sequential stricture dilation and stenting. Stent placement was performed with standard techniques; the interval, size, and number of stents placed at ERCP were determined by the endoscopist. Data retrieved included patient demographics, etiology of stricture, findings at cholangiography, and complications. Hospitalizations due to ERCP or biliary tract disease, comorbid illness and clinical course were obtained from the electronic chart. Results: 11 pts (7 males, 4 females, mean age 62, range 43 - 82) were treated for a mean of 5 years (range 2 to 10 years). Overall, 152 ERCPs were performed with a mean of 13.8 per pt (range 6 to 32). Only one (0.7%) had a post ERCP complication: cholangitis, mild by Cotton criteria. Stents were changed at 4.3 months on average. 6 of 8 (75%) pts treated with scheduled stent changes and all pts stented prn developed biliary sludge. This occurred at a mean 11.4 months from the first ERCP (range 2 to 31 months). Eight pts (73%) required hospitalization for cholangitis with an average stay of 8.5 days (range 6-28 days). Three pts required 2 or more hospitalizations. Two pts died due to biliary disease 3.5 & 4 years into treatment. Need for early stent change, hospitalization, the emergence of intraductal sludge or death could not be correlated to age, sex, number of comorbid illnesses or bilirubin or liver enzymes. Conclusion: 82% of pts treated for benign biliary strictures long-term develop intraductal sludge and require one (73%) or more (27%) hospitalizations as a direct result of their biliary disease and treatment. Repeated biliary stenting in BBDS carries significant morbidity for the patient in the long term. These data should be considered when deciding to begin with long term stent therapy.