Endoscopic Management of Benign Bile Duct Strictures

Baron, Todd H.; DaVee, Tomas

doi:10.1016/j.giec.2013.01.001

Cited by 43 publications

(26 citation statements)

References 122 publications

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“…Besides, the ESGE recommends temporary (one-year) placement of multiple, side-by-side, plastic biliary stents. In our study, the mean number of biliary stents was 4.1 ± 1.2 and the mean number of ERCP sessions was 4.5 ± 1.0, similar to those reported in previous studies[5,6,10-12,19,24]. …”

Section: Discussionsupporting

confidence: 90%

Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

Ohyama¹,

Mikata²,

Ishihara³

et al. 2017

WJGE

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AIMTo investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors.METHODSTen consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared.RESULTSEndoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo.CONCLUSIONSequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy.

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Section: Discussionsupporting

confidence: 90%

Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

Ohyama¹,

Mikata²,

Ishihara³

et al. 2017

WJGE

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“…36 However, different therapeutic strategies are scarce, and SEMS in the case of benign biliary strictures are still under further investigation. 37 Some studies have already shown promising results. 38 However, in case of complex proximal stone formation, the percutaneous transhepatic biliary tract is needed for stone-removal interventions, and SEMS would not be an option in this scenario.…”

Section: Discussionmentioning

confidence: 99%

Drainage-related Complications in Percutaneous Transhepatic Biliary Drainage

Nennstiel¹,

Weber²,

Frick³

et al. 2015

Journal of Clinical Gastroenterology

172

126

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“…Endoscopic stent therapy is a well-established therapeutic approach in patients with biliary obstructive diseases [1] – [3] . However, stent occlusion represents a common complication in patients undergoing stent therapy, which can result in cholestasis or cholangitis [4] , [5] .…”

Section: Introductionmentioning

confidence: 99%

Biliary Endoprosthesis: A Prospective Analysis of Bacterial Colonization and Risk Factors for Sludge Formation

et al. 2014

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Bacterial colonization of biliary stents is one of the driving forces behind sludge formation which may result in stent occlusion. Major focus of the study was to analyze the spectrum and number of microorganisms in relation to the indwelling time of stents and the risk factors for sludge formation. 343 stents were sonicated to optimize the bacterial release from the biofilm and identified by matrix-associated laser desorption/ionization-time of flight mass spectrometer (MALDI-TOF). 2283 bacteria were analyzed in total. The most prevalent microorganisms were Enterococcus species (spp.) (504;22%), followed by Klebsiella spp. (218;10%) and Candida spp. (188;8%). Colonization of the stents mainly began with aerobic gram-positive bacteria (43/49;88%) and Candida spp. (25/49;51%), whereas stents with an indwelling time>60 days(d) showed an almost equal colonization rate by aerobic gram-negative (176/184;96%) and aerobic gram-positive bacteria (183/184;99%) and a high proportion of anaerobes (127/184;69%). Compared to stents without sludge, more Clostridium spp. [(P = 0.02; Odds Ratio (OR): 2.4; 95% confidence interval (95%CI): (1.1–4.9)]) and Staphylococcus spp. [(P = 0.03; OR (95%CI): 4.3 (1.1–16.5)] were cultured from stents with sludge. Multivariate analysis revealed a significant relationship between the number of microorganisms [P<0.01; OR (95%CI): 1.3(1.1–1.5)], the indwelling time [P<0.01; 1–15 d vs. 20–59 d: OR (95%CI): 5.6(1.4–22), 1–15 d vs. 60–3087 d: OR (95% CI): 9.5(2.5–35.7)], the presence of sideholes [P<0.01; OR (95%CI): 3.5(1.6–7.9)] and the occurrence of sludge. Stent occlusion was found in 70/343(20%) stents. In 35% of cases, stent occlusion resulted in a cholangitis or cholestasis. In conclusion, microbial colonization of the stents changed with the indwelling time. Sludge was associated with an altered spectrum and an increasing number of microorganisms, a long indwelling time and the presence of sideholes. Interestingly, stent occlusion did not necessarily lead to a symptomatic biliary obstruction.

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Endoscopic Management of Benign Bile Duct Strictures

Cited by 43 publications

References 122 publications

Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

Drainage-related Complications in Percutaneous Transhepatic Biliary Drainage

Biliary Endoprosthesis: A Prospective Analysis of Bacterial Colonization and Risk Factors for Sludge Formation

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