Short-term Stenting Research Articles

4688 Minor papilla stent therapy in patients with symptomatic pancreas divisum: indications, efficacy and long-term outcome.

PDiv can present as chronic abdominal pain (CAP), episodes of acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). Symptomatic PDiv is usually managed conservatively because of lack of randomized clinical trials to indicate optimal treatment. Preliminary studies suggest promise with endoscopic sphincterotomy (ES) and short-term minor papilla stenting (MPS). AIM:To determine the indications, complications, and long-term outcome in pts with symptomatic PDiv treated with MPS. METHODS: 148 pts (87-W, 61-M, were age 13-72) identified with symptomatic PDiv. Indications ARP=76/148 (51.5%), CAP=43/148 (29%), CP=29/148 (19.5%). Length of stent (5-10 Fr) therapy ranged from 24 wks to 12 mo (F/U 6 mo-12 yrs). Pts lost to F/U, those previously treated with surgery or ES, and those failing cannulation were excluded. Complete response was defined in ARP as no further episodes of pancreatitis and in pts with CAP and CP as resolution of pain. Partial response was defined as at least 50% improvement in episodes of pancreatitis (ARP) and pain (CAP, CP).RESULTS: Complete resolution of symptoms in 51/148 (34.5%), partial resolution in 17/148 (11.5%) and no improvement in 80/148 (54.1%) in all groups combined. Complete response in 39/76 (51.3%) of ARP, 7/43 (16.3%) of CAP, and 5/29 (17.2%) of pts with CP. Further treatment in pts with partial or no response was attempted in 16/76 (21.1%) of ARP, 4/43 (9.3%) of CAP, and 7/29 (24.1%) of CP. ES and surgical therapy in stent partial/non-responders resulted in complete resolution of symptoms in 11/16 (68.8%) of ARP, 0/4 (0%) of CAP, and 2/7 (28.6%) of CP. Complications occurred in 25/76 (32.9%) of ARP, 12/43 (27.9%) of CAP, and 5/29 (17.2%) of CP. CONCLUSION: Endoscopic stent therapy has a modest success rate in ARP, but low success in CAP or CP. ES or surgical intervention in partial/non-responders further assist in resolving symptoms of ARP and CP but not for CAP. Significant complication rate is noted in all pt groups, which may limit use of MPS.

Four years experience with short-term stenting in primary sclerosing cholangitis

Abstract OBJECTIVE: Symptomatic dominant strictures in primary sclerosing cholangitis are often treated with endoscopic stent therapy, but the optimal treatment duration is not well established. After a promising pilot study, we now report our 4 yr experience with short term endoscopic stent therapy for relief of dominant strictures. METHODS: Between January 1994 and October 1997, 32 patients with symptomatic primary sclerosing cholangitis with a dominant stricture at endoscopic retrograde cholangiopancreatography were treated with insertion of a 7- or 10-Fr polyethylene endoprosthesis, which was extracted after a mean of 11 days (range 1–23 days). Primary end points were changes in complaints and cholestasis after 2 months, and time interval until a repeat endoscopic treatment was deemed necessary. A secondary end point was the occurrence of treatment-related complications. RESULTS: Cholestatic complaints improved after 2 months in 83% of patients. Mean scores for pruritus, fatigue, and right upper quadrant pain decreased from 0.94, 1.0, and 0.87 to 0.26, 0.39, and 0.26, respectively. All improvements were significant. Of 14 patients presenting with jaundice, 12 regained normal serum bilirubin levels 2 months after short term endoscopic stenting. The mean levels of conjugated bilirubin, alkaline phosphatase, and γ-glutamyl transpeptidase dropped significantly from 36 μmol/L, 309 U/L, and 426 U/L to 7 μmol/L, 205 U/L, and 258 U/L, respectively. The reintervention-free proportions after 1 and 3 yr were 80% and 60%. Seven transient procedure-related complications occurred in 45 therapeutic endoscopic retrograde cholangiopancreatographies. CONCLUSIONS: Short term endoscopic stenting for symptomatic dominant strictures in primary sclerosing cholangitis is effective and safe, and the beneficial effect is sustained for several years.

Four years experience with short term stenting in primary sclerosing cholangitis

OBJECTIVE: Symptomatic dominant strictures in primary sclerosing cholangitis are often treated with endoscopic stent therapy, but the optimal treatment duration is not well established. After a promising pilot study, we now report our 4 yr experience with short term endoscopic stent therapy for relief of dominant strictures. METHODS: Between January 1994 and October 1997, 32 patients with symptomatic primary sclerosing cholangitis with a dominant stricture at endoscopic retrograde cholangiopancreatography were treated with insertion of a 7- or 10-Fr polyethylene endoprosthesis, which was extracted after a mean of 11 days (range 1–23 days). Primary end points were changes in complaints and cholestasis after 2 months, and time interval until a repeat endoscopic treatment was deemed necessary. A secondary end point was the occurrence of treatment-related complications. RESULTS: Cholestatic complaints improved after 2 months in 83% of patients. Mean scores for pruritus, fatigue, and right upper quadrant pain decreased from 0.94, 1.0, and 0.87 to 0.26, 0.39, and 0.26, respectively. All improvements were significant. Of 14 patients presenting with jaundice, 12 regained normal serum bilirubin levels 2 months after short term endoscopic stenting. The mean levels of conjugated bilirubin, alkaline phosphatase, and γ-glutamyl transpeptidase dropped significantly from 36 μmol/L, 309 U/L, and 426 U/L to 7 μmol/L, 205 U/L, and 258 U/L, respectively. The reintervention-free proportions after 1 and 3 yr were 80% and 60%. Seven transient procedure-related complications occurred in 45 therapeutic endoscopic retrograde cholangiopancreatographies. CONCLUSIONS: Short term endoscopic stenting for symptomatic dominant strictures in primary sclerosing cholangitis is effective and safe, and the beneficial effect is sustained for several years.

Primär sklerosierende Cholangitis – Therapieoptionen

The natural course of primary sclerosing cholangitis (PSC) is highly variable. There is no correlation between the PSC activity and the severity of the bowel disease which occurs simultaneously in more than half of the patients. With this variability in the natural history of the disease, the clinician is faced with difficult decisions regarding the timing of medical and interventional therapy as well as of orthotopic liver transplantation. Immunosuppression is unlikely to be effective in patients with advanced liver disease with an irreversible bile duct Ioss. Ursodeoxycholic acid (UDCA) is now commonly prescribed in PSC since the drug is safe in most patients. High-dose UDCA treatment looked promising in a small pilot study. Therefore this approach probably in combination with immunosuppressive treatment should be investigated in prospective long term controlled trials in patients in the prefibrotic stage. Treatment of the PSC symptoms (itching, steatorrhoea, osteoporosis, bacterial cholangitis) is of paramount importance for the quality of life of the patients. Relapsing cholangitis must be treated aggressively with appropriate antibiotics e. g. ciprofloxacine or mezlocillin plus metronidazole. Balloon dilation and short term stenting will help patients with dominant stenoses of the extrahepatic bile ducts. In late-stage PSC liver transplantation is the only therapeutic option. The 5-year survival rate is good (about 80%). Orthotopic liver transplantation should be performed early in the course of the disease when the operative risk is less. At this stage patients are also less likely to have developed hepatobiliary malignancy. The incidence of colorectal carcinoma in PSC patients with ulcerative colitis is high. Therefore, annual surveillance colonoscopy is recommended in this group of patients.

Lack of complications following short-term stent therapy for extrahepatic bile duct strictures in primary sclerosing cholangitis

Background: In 10% to 20% of patients with primary sclerosing cholangitis, a dominant stricture of an extrahepatic bile duct is responsible for symptoms and an exacerbation of cholestasis. The complications of a dominant stricture can usually be relieved by endoscopic placement of a stent through the stricture. The conventional policy of leaving stents in situ for 2 to 3 months is associated with a high incidence (e.g., 50%) of clinical deterioration due to stent occlusion. We have attempted to overcome this problem by substantially reducing the duration of stent placement. Methods: Sixteen patients with symptomatic primary sclerosing cholangitis and dominant extrahepatic bile duct strictures were treated by stent placement for a median interval of only 9 days. Results: In all patients endoscopic stent therapy was technically successful with a 7% incidence of transient procedure-related complications. During median follow-up of 19 months (range 7 to 27 months) serum biochemical evidence of cholestasis decreased substantially and 13 (81%) of the 16 patients became asymptomatic. No patient had a recurrence or exacerbation of either symptoms or biochemical evidence of cholestasis that could be attributed to stent occlusion. Conclusions: Short-term endoscopic stent therapy is a safe and effective treatment for symptomatic dominant extrahepatic bile duct strictures in patients with primary sclerosing cholangitis. (Gastrointest Endosc 1997;46:344-7.)

Short-term endoscopic stent therapy for dominant extrahepatic bile duct strictures in primary sclerosing cholangitis

Short-term endoscopic stent therapy for dominant extrahepatic bile duct strictures in primary sclerosing cholangitis

Short-term endoscopic stent therapy for dominant extrahepatic bile duct strictures in primary sclerosing cholangitis

Short-term endoscopic stent therapy for dominant extrahepatic bile duct strictures in primary sclerosing cholangitis