LONG-TERM RESULTS OF ENDOSCOPIC TRANSPAPILLARY TREATMENT OF POSTOPERATIVE BILIARY STRICTURES

Abstract

Aim. To evaluate treatment options and long-term results of endoscopic transpapillary interventions for postoperative biliary strictures. Material and Methods. 83 patients with postoperative biliary strictures underwent endoscopic transpapillary interventions. In all cases strictures were caused by iatrogenic injury of the bile ducts. Strictures type «0» were in 18 (21.7%) cases, «+1» in 37 (44.6%) cases, «+2» in 25 patients (30.1%), «–1» in 3 cases. Results. Endoscopic repair of strictures was performed in 64 cases (77.1%) and became final treatment in all of them. Endoscopic management lasted from 8 to 46 months. Time between repeat stenting was 3–4 months. Deployment of two stents was performed in 29 (45.3%) patients, 3 stents – in 9 (14.1%) patients, 4 and 5 stents in 2 and 1 patients, respectively. In 19 (22.9%) out of 83 patients retrograde stenting was failed: in 13 (62%) of 21 patients with strictures type «−1» and «0» and in 6 (9.7%) of 62 patients with strictures type «+1» and «+2», p < 0.01. 16 of 19 patients were further operated. Long-term results were followed-up in 49 (76.5%) patients for the period from 1 to 20 years including 3 patients with strictures «−1» and «0» and 46 patients with strictures type «+1» and «+2». Good, satisfactory and unsatisfactory long-term results were obtained in 42 (85.7%), 4 (8.2%) and 3 (6.1%) patients, respectively. Conclusion. Endoscopic transpapillary repair of postoperative biliary strictures is technically feasible and provides stable positive result in more than 90% of patients with strictures type «+1» and «+2». Technical possibility and positive results of stenting were achieved in 33% of stricture type «−1» and in 39% of type «0». Unsatisfactory long-term results were observed in 6% of patients and were associated with high extent type of stricture.