Temporary endobiliary stenting of distal strictures of the common bile duct due to chronic pancreatitis

Abstract

Aim.To determine the possibility, necessity and safety of self-expanding covered endobiliary stents in benign biliary strictures caused by chronic pancreatitis.Material and methods.Nine patients with painless chronic pancreatitis complicated by obstructive jaundice syndrome were enrolled. Minimally invasive treatment included stage-by-stage percutaneous transhepatic cholangiostomy by pigtail 8Fr drain followed by its transformation to temporary transpapillary external-internal drainage. Then we performed antegrade endobiliary stenting of stricture with self-expanding metal stent 9 mm. There were no symptoms of acute pancreatitis. External-internal drainage in within bile duct lumen has been kept for 2–4 weeks to control position and patency of the stent.Results.Technical success of antegrade deployment of self-expanding covered stent into transpapillary position was achieved in all patients. The time of complete opening of the stent was 2 days. Ultrasonic control every 2 months was applied since stent has been installed. All 9 stents were successfully and uneventfully extracted endoscopically after 6–12 months. There were no cases of recurrent mechanical jaundice. Mean disease-free follow-up was 22.8 months.Conclusion.Covered stent opening followed by stricture dilation up to 8-10 mm within distal common bile duct confidently eliminates biliary hypertension. Stenting of this area is followed by formation of stable periductal carcass within 6–9 months which is preserved even after endoscopic extraction of the stent. Minimally invasive management of biliary hypertension using covered self-expanding metal stent in transpapillary position may be an alternative to traditional surgery in selected patients with chronic pancreatitis and mechanical jaundice as predominant clinical syndrome.