Management of benign biliary strictures by percutaneous interventional radiologic techniques (PIRT)

Abstract

Introduction. Some biliary strictures may be manageable by percutaneous interventional radiologic techniques (PIRT), but long-term efficacy of this approach is scarce. Methods. We reviewed retrospectively all patients with biliary strictures secondary to traumatic bile duct injury or strictured bilioenteric anastomoses. Patients in whom the initial management was by PIRT from 1998 through 2003 were selected. Subjects with sclerosing cholangitis, hepatic transplantation, or malignant strictures were excluded. Data were obtained from medical records and/or direct patient contact. Comparisons were made by Fisher's exact test and Wilcoxon rank-sum test. Results. Twenty-seven patients with biliary strictures were treated by PIRT. Mean age was 54 years (range 11–86). Most frequent etiology was laparoscopic cholecystectomy injury in 11 patients (41%). Eight patients (29%) had undergone biliary resection for malignancy, seven (26%) a pancreatoduodenectomy, and one for presumed ischemic cholangiopathy; no strictures were secondary to neoplastic recurrence. PIRT was successful in 10 of 11 patients (91%) with short, isolated bile duct strictures secondary to laparoscopic cholecystectomy and in seven of 15 patients (41%) with strictured bilioenteric anastomosis, but not in the patient with ischemic cholangiopathy. Twenty patients (74%) were stent-free at follow-up. Anastomotic biliary strictures were more likely to fail PIRT than isolated strictures secondary to laparoscopic cholecystectomy injury (p=0.02). Conclusion. Percutaneous balloon dilatation and stenting can be an effective strategy for patients with bile duct strictures, especially short bile duct strictures after laparoscopic cholecystectomy. Anastomotic strictures are associated with less good results when managed by PIRT but are successful in up to 40% of patients.