Treatment Of Benign Biliary Strictures Research Articles

Off-label use of Lumen-apposing metal stents for treatment of short benign biliary strictures

BackgroundEndoscopic stenting is the mainstay of treatment for benign biliary strictures. There is a not-negligible rate of recurrence and stent migration. Lumen-apposing metal stents (LAMS) have a unique design with short length, large diameter and wide flanges which make them less prone to migration. AimsTo describe the intraluminal use of LAMS to treat short benign biliary strictures. MethodsAll consecutive patients who underwent bi-flanged LAMS placement for benign biliary strictures, in approximately 6 years, were retrospectively included. Primary outcomes were technical and clinical success; secondary outcomes were number of endoscopic procedures, adverse events evaluation and stricture recurrence during follow-up. ResultsSeventy patients (35 male, mean age 67) were enrolled; bilio-enteric anastomotic stricture was the most common etiology. Technical and clinical success were 100 % and 85.7 %, respectively. Patients with post-surgical stricture had a higher success rate than patients with non-surgical stricture or with bilio-enteric anastomotic stricture (90.4 %, 86.3 % and 81.4 %, respectively). Adverse events were 12/70 (17.1 %): stent migration was the most frequent (8/70, 11.4 %). Stricture recurrence was found in 10/54 patients (18.5 %). ConclusionLAMS placement could be safe and effective treatment for short benign biliary strictures in patients in which a significant caliber disproportion between stricture and the duct above was revealed.

Anti-fibrotic and anti-stricture effects of biodegradable biliary stents braided with dexamethasone-impregnated sheath/core structured monofilaments

Endoscopic biliary stent insertion has been widely used for the treatment of benign biliary stricture (BBS). Thus, the development of stent materials in the perspectives of structure, mechanical properties, and biocompatibility has been also studied. However, conventional metal and plastic stents have several disadvantages, such as repeated procedures to remove or exchange them, dislodgment, restenosis, biocompatibility, and poor mechanical properties. Sustainable effectiveness, attenuation and prevention of fibrosis, and biocompatibility are key factors for the clinical application of stents to BBS treatment. In addition, loading drugs could show synergistic effects with stents’ own performance. We developed a dexamethasone-eluting biodegradable stent (DBS) consisting of a sheath/core structure with outstanding mechanical properties and sustained release of dexamethasone, which maintained its functions in a BBS duct over 12 weeks in a swine model. The insertion of our DBS not only expanded BBS areas but also healed secondary ulcers as a result of the attenuation of fibrosis. After 16 weeks from the insertion, BBS areas were totally improved, and the DBS was degraded and thoroughly disappeared without re-intervention for stent removal. Our DBS would be an effective clinical tool for non-vascular diseases. Statement of significanceThis study describes the insertion of a drug-eluting biodegradable stent (DBS) into the bile duct. The sheath/core structure of DBS confers substantial durability and a sustained drug release profile. Drug released from the DBS exhibited anti-fibrotic effects without inflammatory responses in both in vitro and in vivo experiments. The DBS maintained its function over 12 weeks after insertion into the common bile duct, expanding benign biliary stricture (BBS) and reducing inflammation to heal secondary ulcers in a swine BBS model. After 16 weeks from the DBS insertion, the DBS thoroughly disappeared without re-intervention for stent removal, resulting in totally improved BBS areas. Our findings not only spotlight the understanding of the sheath/core structure of the biodegradable stent, but also pave the way for the further application for non-vascular diseases.

The utility of self-expanding metal stents in benign biliary strictures- a retrospective case series

BackgroundBenign biliary strictures can have a significant negative impact on patient quality of life. There are several modalities which can be utilized with the goal of stricture resolution. These techniques include balloon dilatation, placement of multiple plastic stents and more recently, the use of metal stents. The aim of this study was to evaluate the local success of self-expanding metal stents in successfully resolving benign biliary strictures.MethodsThis was a single institution, retrospective case series. Patients included in our study were patients who underwent endoscopic retrograde cholangiopancreatography with placement of self expanding metal stents for benign biliary strictures at our institution between 2016–2022. Patients were excluded for the following: malignant stricture, and inability to successfully place metal stent. Data was evaluated using two-sided t-test with 95% confidence interval.ResultsA total of 31 patients underwent placement of 43 self-expanding metal stents and met inclusion criteria. Mean age of patients was 59 ± 10 years, and were largely male (74.2% vs. 25.8%). Most strictures were anastomotic stricture post liver transplant (87.1%), while the remainder were secondary to chronic pancreatitis (12.9%). Complications of stent placement included cholangitis (18.6%), pancreatitis (2.3%), stent migration (20.9%), and inability to retrieve stent (4.7%). There was successful stricture resolution in 73.5% of patients with anastomotic stricture and 33.3% of patients with stricture secondary to pancreatitis. Resolution was more likely if stent duration was > / = 180 days (73.3% vs. 44.4%, p < 0.05). There was no demonstrated added benefit when stent duration was > / = 365 days (75% vs. 60.9%, p = 0.64).ConclusionsThis study demonstrates that self expanding metal stents are a safe and effective treatment for benign biliary strictures, with outcomes comparable to plastic stents with fewer interventions. This study indicates that the optimal duration to allow for stricture resolution is 180–365 days.

Transfistula antegrade interventions in the treatment of benign biliary strictures

Background. Primary reconstructive operations aimed at restoring the passage of bile are rather complicated due to the cicatricial process and in 1530% lead to a distant recurrence of the disease.&#x0D; Aim. To present the results of combined X-ray surgery and endoscopic transfistula antegrade interventions in the treatment of benign bile duct strictures.&#x0D; Material and methods. For the period from 2011 to 2019 31 patients with benign bile duct strictures were treated in the surgical departments of the City Clinical Hospital No. 14 in Yekaterinburg. The mean age of the patients was 60.312.7 years, the comorbidity index was 2.6. As follows from the presented data, in 13 patients the stricture developed in the area of biliodigestive anastomoses. Another 17 patients had stricture after surgery for cholelithiasis. In 1 case, there was a persistent narrowing of the lumen of the choledochus against the background of indurative pancreatitis. In 25 (80.6%) cases, the first step was percutaneous transhepatic cholangiostomy under ultrasound guidance. Another 6 (19.4%) patients had a T-shaped drainage of the choledochus.&#x0D; Results. For the treatment of strictures of the bile ducts, 97 operations were performed: an average of 3.1 operations per 1 patient. Lithoextraction with a wire basket was performed in 17 patients with calculi. 5 patients with stones larger than 10 mm required contact lithotripsy. Stricture was confirmed in 25 patients. Balloon dilatation was performed in 21 cases. In 8 cases, dilatation was supplemented with papillosphincterotomy. In 6 patients with deformation of the anastomosis zone, framed drainage was installed for 12 months. In 3 patients, bilioduodenal stenting with a nitinol stent was performed. It was not possible to recanalize the stricture in 4 (13%) cases. Complications were registered in 1 (3.2%) patient (IIIB degree according to ClavienDindo).&#x0D; Conclusion. Transfistula cholangioscopy is an effective endoscopic technology in the treatment of patients with benign bile duct strictures.

Effect of fully covered self-expandable metal stents completely inserted into the common bile duct in the treatment of benign biliary stricture

Objective: To investigate the safety and efficacy of fully covered self-expandable metal stents(FCSEMS) completely inserted into the common bile duct in the treatment of benign biliary stricture(BBS). Methods: From December 2018 to December 2020, 22 cases of BBS treated by FCSEMS completely inserted into the common bile duct were analyzed retrospectively in the cholelithic center of Shanghai East Hospital Affiliated to Tongji University, including 12 males and 10 females, with average ages of (50.9±8.6) years. Results: All 22 cases of FCSEMS insertion were successful. The average indwelling time was (221.9±19.8) d. There were no complications of enterobiliary reflux such as liver abscess, acute cholangitis, and common bile duct obstruction. FSCEMS proximal displacement occurred in 2 cases (9.1%) with the removal time of 62 min and 115 min, respectively. There was no FCSEMS proximal displacement in 20 cases (90.9), with an average removal time of (29.7±6.3) min. All the 22 cases were followed up for 16.0 (8.0, 25.3) months, and there was no recurrence of stenosis. Conclusion: FCSESM completely inserted into the common bile duct is an effective method for the treatment of BBS, which can avoid the occurrence of enterobiliary reflux.

Preclinical evaluation of endoscopic placement of a steroid-eluting metal stent in an in vivo porcine benign biliary stricture model

Treatment of benign biliary strictures (BBS) using fully covered self-expandable metal stents (FCSEMS) has a high success rate, but recurrence can occur. Corticosteroids may be useful based on their anti-fibrotic and anti-inflammatory effects. We investigated the safety and efficacy of corticosteroid-eluting FCSEMS in an animal model. BBSs were created by radiofrequency ablation in 12 mini-pigs. Four weeks later, FCSEMS coated with 0 mg (control), 15 mg (steroid 1 × group), or 30 mg (steroid 2 × group) triamcinolone were inserted endoscopically. The in vitro drug release assay revealed that the optimal stent had 15 mg of triamcinolone and a hydrophilic membrane. No transmural necrosis or perforation occurred in any animal. Fibrous wall thickness tended to decrease macroscopically and microscopically in a triamcinolone dose-dependent manner (control vs. steroid 2 × group: 773.1 vs. 468.5 µm, P = 0.037). Thickness also decreased over time in the steroid 2 × group (3 days vs. 4 weeks: 907.9 vs. 468.5 µm, P = 0.025). Blood parameters tended to improve after stent insertion. In a porcine BBS model, steroid-eluting FCSEMS showed potential as a safe and effective treatment modality to reduce fibrotic tissue. Studies are required to confirm their safety and efficacy in humans with refractory BBS.

Percutaneous Transhepatic Treatment of Benign Bile Duct Strictures Using Retrievable Covered Stents: Long-Term Outcomes in 148 Patients.

ObjectiveTo investigate the long-term outcomes of percutaneous treatment of benign biliary strictures using temporary placement of a retrievable expanded polytetrafluoroethylene (PTFE) covered stent.Materials and MethodsWe retrospectively analyzed the outcomes of 148 patients (84 male and 64 female; age range, 11–92 years) who underwent percutaneous transhepatic placement and removal of a retrievable PTFE-covered stent for the treatment of benign biliary strictures between March 2007 and August 2019 through long-term follow-up. Ninety-two patients had treatment-naïve strictures and 56 had recurrent/refractory strictures.ResultsStent placement was technically successful in all 148 patients. The mean indwelling period of the stent was 2.4 months (median period, 2.3 months; range, 0.2–7.7 months). Stent migration, either early or late, occurred in 28 (18.9%) patients. Clinical success, defined as resolution of stricture after completing stent placement and removal, was achieved in 94.2% (131 of 139 patients). The overall complication rate was 15.5% (23 of 148 patients). During the mean follow-up of 60.2 months (median period, 52.7 months; range, 1.6–146.1 months), 37 patients had a recurrence of clinically significant strictures at 0.5–124.5 months after removal of biliary stent and catheter (median, 16.1 months). The primary patency rates at 1, 3, 5, 7, and 10 years after removal of biliary stent and catheter were 88.2%, 70.0%, 66.2%, 60.5%, and 54.5%, respectively. In the multivariable Cox proportional hazard regression analysis, sex, age, underlying disease, relation to surgery, stricture type, biliary stones, history of previous treatment, and stricture site were not significantly associated with the primary patency.ConclusionLong-term outcomes suggest that percutaneous treatment of benign biliary strictures using temporary placement of retrievable PTFE-covered stents may be a clinically effective method.

Study of clinical profile of benign biliary strictures in a tertiary care centre: an observational study

Background and Aim: Benign biliary strictures (BBSs) may arise from chronic inflammatory pancreaticobiliary pathologies, postoperative bile-duct injury, or at biliary anastomosis following liver transplantation. Endoscopic therapies, like stricture dilatation and stenting, are effective in most cases and the first-line treatment of BBS. We aim to study the different etiologies, clinical manifestations, response to treatment and their clinical progression over 1 year

Bio-Degradable Stents: Primary Experience in a Tertiary Hepatopancreaticobiliary Center in the United Kingdom.

Background: Management of benign biliary strictures (BBS) post bilioenteric anastomoses requires a multidisciplinary approach including surgical, radiological, and/or endoscopic input. Patients often need multiple hospital visits for treatment with the long-term possibility of restenosis. Conventionally BBS have been treated with serial percutaneous transhepatic biliary dilatations necessitating repeat procedures for drain exchange or removal. Surgery may become necessary in refractory strictures. In the last decade, there have been increasing reports of the use of biodegradable stents (BDS) in treating biliary strictures mainly to address the need for repeated procedures for drain exchange.Aim: This study aimed to report the early outcomes in patients with BBS treated with BDS.Methods: Retrospective analysis of prospectively collected data was performed in patients who had a bilioenteric anastomosis presenting with an anastomotic stricture and were intended to be treated with BDS. The primary endpoints reported were technical success (defined as a successful resolution of stricture on repeat cholangiogram) and clinical success (defined as the absence of repeated cholangitis). Clavien-Dindo (CD) grade of complication was reported.Results: Twelve patients presented with BBS and nine patients had BDS. Three patients were not considered suitable for BDS due to a non-traversable stricture and had surgery. The male-female ratio was 1:2. There was 100% technical and clinical success with one patient having stent migration not needing intervention. The procedure took an average of 45 min. In seven (77.7%) patients, it was safely performed under local anesthesia with sedation. Two patients preferred general anesthesia. There was no restenosis noted at a median follow-up of 11 months.Conclusion: The use of BDS in the treatment of BBS is a safe and effective procedure. Longer-term follow-up with multi-institutional reporting on a national database is needed to assess its long-term benefits.

Biodegradable JDBM coating stent has potential to be used in the treatment of benign biliary strictures

In our previous study, to find out the optimal alloy suitable for biliary surgery, magnesium alloy Jiao Da Bio-magnesium (denoted as JDBM) alloy, Zn–3Cu alloys, and their respective coating (MgF2–PDLLA) products were produced for our research. We found that JDBM seems to be a potential material for clinical biliary stent application due to its uniform degradation and good compatibility. In order to apply the JDBM alloy to treat benign bile duct stricture, our group prepared the bare JDBM and its coating product into finished stents by mesh weaving carving technology and conducted the mechanical property tests, degradation tests and biocompatibility tests. During the mechanical property tests, we found the bare JDBM stent was more suitable than titanium alloy stent when applies to the bile duct, and the coating of the JDBM coating stent has no effect on its mechanical properties. Our in vitro and in vivo experiments revealed that the degradation rate of the JDBM coating stent is lower than that of the JDBM stent, and both stents were biosafe. Thus, there is promise for JDBM coating stents for the treatment of benign biliary strictures.

Bilateral balloon expandable biodegradable stent (Y-stent) for postcholecystectomy perihilar biliary stricture.

Bilateral balloon expandable biodegradable stent (Y-stent) for postcholecystectomy perihilar biliary stricture.

Current status of endoscopic diagnosis and treatment of benign biliary stricture

Benign biliary stricture (BBS) refers to complete or incomplete stricture of the biliary tract caused by a series of non-malignant diseases. BBS often has complex and diverse etiologies, and severe complications may occur if it is not adequately treated. Diagnostic methods currently used in clinical practice include imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, and choledochoscopy, and treatment methods include balloon dilatation, stent implantation, percutaneous transhepatic biliary drainage, and surgical treatment. At present, endoscopic diagnosis and treatment of BBS has become the preferred method. However, there is still no clear classification of BBS, which needs further investigation. By consulting related literature in China and globally, this article summarizes the issues associated with the endoscopic diagnosis and treatment of BBS.

Endoscopic treatment of benign biliary stricture using different stents: a systematic review and meta-analysis.

IntroductionBiodegradable biliary stents (BDBSs), fully covered self-expanded metal stents (FCSEMSs) and multiple plastic stents (MPSs) were common stents in endoscopic treatment of benign biliary stricture (BBS).AimTo evaluate the effectiveness of these 3 stents in BBS management.Material and methodsThe PubMed, Web of Science, Cochrane Library, and Wiley Library databases were searched for studies that provided data about BBS and stent therapy.ResultsWe found that BDBSs were associated with the highest clinical success rate (0.76, 95% CI: 0.71–0.80), followed by MPSs (0.69, 95% CI: 0.63–0.74), and FCSEMSs (0.67, 95% CI: 0.63–0.71). BDBSs also had a relatively high probability of technical success, at 1.00 (95% CI: 1.00–1.00), superior to MPSs (0.95, 95% CI: 0.88–0.99) and FCSEMSs (0.90, 95% CI: 0.85–0.94). The treatment success rate for BDBSs (1.00, 95% CI: 1.00–1.00) was also higher than for MPSs (0.88, 95% CI: 0.72–0.98) and FCSMESs (0.82, 95% CI: 0.76–0.87). However, BDBSs had the highest stricture recurrence rate (0.21, 95% CI: 0.16–0.26), compared with FCSEMSs (0.11, 95% CI: 0.08–0.15) and MPSs (0.07, 95% CI: 0.03–0.13).ConclusionsPatients with BBS are likely to receive a satisfied outcome when treated with BDBSs.

Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

BackgroundPostoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle.Case presentationA 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma.ConclusionsRecanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

Diagnosis and treatment of benign biliary stricture except for PSC and IgG4 related-disease

Diagnosis and treatment of benign biliary stricture except for PSC and IgG4 related-disease

1170 ENDOSCOPIC TRANSPAPILLARY GALLBLADDER STENT PLACEMENT TO PREVENT ACUTE CHOLECYSTITIS IN PATIENTS RECEIVING FULLY COVERED SELF EXPANDING METAL STENTS FOR BENIGN BILIARY STRICTURE

Treatment of benign biliary strictures (BBS) with fully covered self-expanding metal stents (FCSEMS) has become common practice due to its deceased number of endoscopic sessions and its efficacy in resolution of benign strictures. However, placement of FCSEMS for BBS poses intrinsic risk, including stent migration, pancreatitis and acute cholecystitis at a rate of 2.9% to 12%. Prophylactic endoscopic transpapillary gallbladder stenting (ETPGBS) during the same ERCP session can allow continuous gallbladder drainage and prevent acute cholecystitis from occlusion of cystic duct orifice by the FCSEMS. The aim of this study was to assess the technical feasibility, efficacy, and safety of ETPGBS prior to placement of FCSEMS for BBS for prevention of acute cholecystitis. This is a retrospective analysis of a prospectively collected database at a single tertiary-care referral center of all patients who underwent FCSEMS for BBS with prophylactic endoscopic transpapillary gallbladder stent placement between 12/1/2016 and 11/30/2019. Demographic, endoscopic, imaging, clinical management, and follow-up data was abstracted and analyzed. A total of 46 transpapillary GB stents were placed during the study period. Selective cystic duct and gallbladder wire cannulation was achieved followed by successful placement of ETPGBS in all patients (technical success 100%). 10 patients underwent ETPGBS prior to biliary FCSEMS during the same endoscopic session. (Figure) The mean age was 69 ± 21.83 years, and the majority of patients were male (80%). A 7 Fr by 22 cm low-profile, soft, plastic double-pigtail gallbladder stent with larger inner lumen was used in all cases. In all cases, a 10 mm diameter FCSEMS (length ranging from 40 mm to 100 mm; 60 mm being the most common) was placed in the common bile duct. There was significant improvement in total bilirubin level (pre-procedural 4±3.08 vs post-procedural 1.27±1.1 gm/dL with mean reduction of 2.73±1.27; p=0.04). FCSEMS were left in place (stent dwell time) for a median of 139 (range: 87-291; mean 164±68) days with resolution of BBS and successful removal of ETPGBS and FCSEMS in all patients. No episodes of acute cholecystitis or any other post-procedural complications were noted during the median follow-up of 126 (range: 3-380; mean 169±147) days. Treatment of BBS with FCSEMS has become an increasingly common alternative therapy to plastic biliary stents. However, rates of acute cholecystitis have been documented as high as 12%. Endoscopic transpapillary gallbladder stent placement prior to FCSEMS in our study demonstrated an effective treatment of BBS without an increase in procedural or post-procedural complications. ETPGBS prevented post-procedural acute cholecystitis with continued efficacy of FCSEMS.

Fully covered self-expanding metal stents for benign biliary stricture after orthotopic liver transplant: 5-year outcomes

Minimally invasive treatments of anastomotic benign biliary stricture (BBS) after orthotopic liver transplantation (OLT) include endoscopic placement of multiple plastic stents or fully covered self-expandable metal stents (FCSEMSs). No multiyear efficacy data are available on FCSEMS treatment after OLT. We prospectively studied long-term efficacy and safety of FCSEMS treatment in adults aged≥18 years with past OLT, cholangiographically confirmed BBS, and an indication for ERCP with stent placement. Stent removal was planned after 4 to 6 months, with subsequent follow-up until 5 years or stricture recurrence. Long-term outcomes were freedom from stricture recurrence, freedom from recurrent stent placement, and stent-related serious adverse events (SAEs). In 41 patients, long-term follow-up began after FCSEMS removal (n= 33) or observation of complete distal migration (CDM) (n= 8). On an intention-to-treat basis, the 5-year probability of remaining stent-free after FCSEMS removal or observation of CDM was 48.9% (95% confidence interval [CI], 33.2%-64.7%) among all patients and 60.9% (95% CI, 43.6%-78.2%) among 31 patients with over 4 months of FCSEMS indwell time. In 28 patients with stricture resolution at FCSEMS removal or observed CDM (median, 5.0 months indwell time), the 5-year probability of no stricture recurrence was 72.6% (95% CI, 55.3%-90%). Sixteen patients (39%) had at least 1 related SAE, most commonly cholangitis (n= 10). By 5 years after temporary FCSEMS treatment of post-OLT BBS, approximately half of all patients remained stent-free on an intention-to-treat basis. Stent-related SAEs (especially cholangitis) were common. FCSEMS placement is a viable long-term treatment option for patients with post-OLT BBS. (Clinical trial registration number: NCT01014390.).

Absorbable stents for treatment of benign biliary strictures: long-term follow-up in the prospective Spanish registry.

Benign strictures of the bile duct may be difficult to treat endoscopically due to altered bowel anatomy. Furthermore, recurrence of stenosis and symptoms remains high. The aim of the Spanish Prospective Registry BiELLA study was to investigate the safety and efficacy of absorbable stents in the treatment of benign biliary strictures and their outcomes on the medium and long-term follow-up. A prospective, multicenter, observational, non-randomized study (the BiELLA study) was conducted from January 2014 to September 2018. One hundred fifty-nine patients with benign biliary strictures, mostly postsurgical, were enrolled for implantation of absorbable biliary stents in the 11 participating Spanish tertiary hospitals. The average patient follow-up was 45.4 ± 15.9months (range, 12-60months). The follow-up data included symptoms, biochemical parameters, and ultrasound images at 1, 6, and 12months and then yearly for up to 60months. The immediate technical and clinical success rates were 100%. In all patients, stent placement resulted in improvement of clinical symptoms and biochemical parameters. The primary mean patency for stent was 86.7, 79.6, and 78.9% at 12, 36, and 60months, respectively (95% CI). Biliary restenosis and occlusion occurred in 40 (26.6%) patients. Of the 40 patients, 18 (12%) patients were treated with a second stent and 22 (14.6%) patients had operative repair of the recurrent strictures. There were no major complications associated with stent implantation. Implantation of an absorbable polydioxanone biliary stent is safe and effective for treatment of benign biliary strictures refractory to balloon dilatation or other biliary intervention. • Percutaneous implantation of biodegradable prostheses for the treatment of benign postsurgical biliary strictures is a safe and effective procedure. • More than 75% of the patients presented patency of the stented biliary tree at 5years follow-up. • Absorbable stents improved clinical symptoms and signs (jaundice, itching, fever), and laboratory parameters in a few days after stent placement.

The use of a 532-nm laser fitted with a balloon and a cylindrical light diffuser to treat benign biliary stricture: a pilot study

Endoscopic management of benign biliary stricture (BBS) remains challenging. Stenting is currently used for BBS management, but refractory BBS remains problematic. The aim of this study was to assess the safety and feasibility of a dilation balloon-equipped cylindrical light diffuser for BBS in a large animal model. A total of seven mini-pigs were used in the current study. Laser settings were chosen based on the findings of a previous animal study. Five animals were used in a preliminary study to establish process conditions. BBSs were created in the common bile ducts of the other two animals by intraductal radiofrequency ablation (RFA) via endoscopic retrograde cholangiography (ERC). At 4weeks post-RFA, laser ablation was performed using a customized balloon-equipped cylindrical diffuser at 10W for 10s while maintaining balloon inflation for 10s at 5atm. A follow-up ERC was performed at 4weeks post-laser ablation and the animals were sacrificed for histologic evaluation. BBS was observed in all animals by ERC at 4weeks post-RFA. The mean bile duct stricture diameter in the two animals as determined by ERC was 0.8mm. Laser ablations were performed without technical difficulty and no adverse event was encountered. At 4weeks post-laser ablation, mean biliary stricture diameter had dilated to 1.6mm on cholangiographic finding. On histologic examination, inflammatory cell infiltration in lamina propria and dense collagen deposition were observed, but there was no evidence of bile duct perforation. The devised balloon-equipped cylindrical laser light diffuser appears to be safe and feasible for the treatment of BBS. However, further studies and modifications are required before it can be applied clinically as a monotherapy.

Biodegradable versus multiple plastic stent implantation in benign biliary strictures: A systematic review and meta-analysis

PurposeBenign biliary strictures arise mostly from iatrogenic injuries during surgical procedures and various inflammatory causes. Endoscopic placement of multiple plastic stents (MPS) is often regarded as the first-line therapy, albeit not without limitations. Biodegradable biliary stents (BDBS) present an alternative therapeutic option aimed at overcoming these shortcomings.The long-term stricture resolution rates between BDBS and MPS implantation in patients with benign biliary strictures (BBS) was therefore analyzed and compared, regardless of etiology. MethodUsing predefined data fields, all articles published up to July 2018 were retrospectively selected and independently extracted by two authors and then excluded according to predefined criteria. Additional studies were identified by manually searching through article references. Any disagreements between authors on study selection were resolved by consensus. Results3 studies for BDBS (n = 133) and 6 for MPS technique (n = 441) met the inclusion criteria. The overall success rate (defined as no stricture recurrence during follow-up) for BDBS implantation was 83 % (95 % [CI], 0.76–0.89), compared to 84 % (95 % [CI], 0.78–0.89) in the MPS group. Overall stent-related complication rates were reported to be slightly inferior in the BDBS group when compared to MPS, except for cholangitis (24.1 % vs. 6.1 %, respectively) and haemobilia (3% vs <1%, respectively). On average, BDBS required less interventions than MPS use (1 vs. 3, respectively). ConclusionsThe insertion of BDBS in the treatment of benign biliary strictures does not seem to be inferior to multiple plastic stents in resolving and maintaining long-term biliary duct patency, albeit exhibiting higher rates of post-procedural cholangitis.