Researchers from Italy have reported results from more than 10 years of follow-up showing that the placement of multiple endoscopic stents for the treatment of postoperative biliary strictures remains excellent with a low rate of stricture recurrence after this lengthy period of time.
When strictures do recur, they can be safely and successfully retreated endoscopically. The study appears in the September issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).
Most patients with biliary strictures, also called bile duct stricture, remain asymptomatic until the lumen of the bile duct is narrowed to cause resistance to the flow of bile. Bile is a fluid secreted by the liver via the bile ducts and is concentrated in the gallbladder before moving into the intestines. With the advent of laparoscopic cholecystectomy (gallbladder removal), the incidence of bile duct injuries has increased significantly. There are approximately 750,000 cholecystectomies performed in the United States each year. Although biliary strictures may be asymptomatic, if ignored, they can cause life-threatening complications. While strictures of the bile duct can be benign or malignant, approximately 80 percent of benign strictures occur following injury during a cholecystectomy.
Three kinds of treatment for biliary strictures are available: surgical, endoscopic and percutaneous. In 2001, a method for endoscopic management of postoperative biliary strictures was reported that included the placement of multiple stents until stricture resolution. A stent is a short narrow metal or plastic tube in mesh form that is inserted into the lumen of an anatomical vessel (such as an artery or bile duct) to keep a previously blocked passageway open. The initial results of this method were very promising, with a mean patient follow-up of four years.
"We first described endoscopic dilation of postoperative biliary strictures using an increasing number of stents in 2001. A group of 42 patients from that study underwent systematic follow-up, with the last follow-up by telephone in 2009," said study lead author Guido Costamagna, MD, Digestive Endoscopy Unit, Catholic University, Rome, Italy. "Our current study of these patients confirmed very good results of endoscopic treatment by insertion of multiple plastic stents after a follow-up period of more than 10 years. The stricture recurrence rate was low; if recurrence does occur, it may be safely and successfully retreated by endoscopic retrograde cholangiopancreatography."
Patients and Methods
The study objectives were to verify results of endoscopic treatment of postoperative biliary strictures at a very long-term follow-up. The study was conducted at a single tertiary-care academic referral center in Italy. A group of 42 patients from the researchers' 2001 study who had undergone endoscopic dilation of postoperative biliary strictures with a technique employing placement of multiple endoscopic stents, underwent systematic follow-up. The patients were asked to undergo liver function tests and transabdominal ultrasound every six months from the end of treatment, and a telephone interview was done yearly to assess the occurrence of cholangitis (inflammation of the bile duct) and to evaluate the results of liver function tests and ultrasound. These study endpoints were consistent throughout the study period starting from the first series. During the yearly follow-up, patients were asked to provide the researchers with the reports of liver function tests and ultrasound. The last telephone follow-up was done in September 2009. The main outcomes were the occurrence of cholangitis and liver function test evaluation during the follow-up period.
Of the 40 patients who were alive at the end of the study published in 2001, five patients (12.5 percent) died of unrelated causes after a mean of 6.7 years from the end of treatment, without further biliary symptoms. The overall mean follow-up time for the remaining 35 patients was 13.7 years. Seven patients (20 percent) experienced recurrent acute cholangitis after a mean of 6.8 years from the end of treatment. All seven of these patients underwent endoscopic retrograde cholangiopancreatography (ERCP). Four of the seven patients had postoperative biliary stricture recurrence (11.4 percent of the 35 patients) that was retreated endoscopically with the placement of stents, and the other three patients had common bile duct stones (8.6 percent of the 35 patients) that were extracted. No stricture or bile duct stone recurrences after retreatment were recorded after a mean follow-up period of an additional 7.1 years. Twenty-eight patients (80 percent) remained asymptomatic with normal liver function test results and abdominal ultrasound results after a mean follow-up period of 13.7 years.
The researchers noted that the main limitations of endoscopic treatment of postoperative biliary strictures by the multiple endoscopic stenting method are the need for multiple ERCPs and repeated hospitalizations, leading to high costs and potentially limited patient compliance. In the researchers' experience, after the risks and benefits of the possible treatments were explained to the patient, with the help of the hepatobiliary surgeon, patients asked for endoscopic treatment and retreatment, if needed.
The researchers concluded that endoscopic stenting with the aim of inserting multiple plastic stents is a reasonable, first-line approach in the treatment of postsurgical strictures; results of the aggressive endoscopic approach to postoperative biliary stricture management after a mean follow-up period of 13.7 years are very good, with 80 percent of patients having excellent results and an 11.4 percent stricture recurrence rate after more than six years from the end of initial treatment. Furthermore, cholangitis in these patients is not always related to postoperative biliary stricture recurrence, but can be secondary to stone formation, as occurred in three of seven (43 percent) of the patients reported in this study.
About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with more than 11,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.
Endoscopy is performed by specially-trained physicians called endoscopists using the most current technology to diagnose and treat diseases of the gastrointestinal tract. Using flexible, thin tubes called endoscopes, endoscopists are able to access the human digestive tract without incisions via natural orifices. Endoscopes are designed with high-intensity lighting and fitted with precision devices that allow viewing and treatment of the gastrointestinal system.
Anne Brownsey | EurekAlert!
The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig
Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)
The WHO reports an estimated 429,000 malaria deaths each year. The disease mostly affects tropical and subtropical regions and in particular the African continent. The Fraunhofer Institute for Silicate Research ISC teamed up with the Fraunhofer Institute for Molecular Biology and Applied Ecology IME and the Institute of Tropical Medicine at the University of Tübingen for a new test method to detect malaria parasites in blood. The idea of the research project “NanoFRET” is to develop a highly sensitive and reliable rapid diagnostic test so that patient treatment can begin as early as possible.
Malaria is caused by parasites transmitted by mosquito bite. The most dangerous form of malaria is malaria tropica. Left untreated, it is fatal in most cases....
The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.
Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...
Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.
That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...
Computer Tomography (CT) is a standard procedure in hospitals, but so far, the technology has not been suitable for imaging extremely small objects. In PNAS, a team from the Technical University of Munich (TUM) describes a Nano-CT device that creates three-dimensional x-ray images at resolutions up to 100 nanometers. The first test application: Together with colleagues from the University of Kassel and Helmholtz-Zentrum Geesthacht the researchers analyzed the locomotory system of a velvet worm.
During a CT analysis, the object under investigation is x-rayed and a detector measures the respective amount of radiation absorbed from various angles....
The quantum world is fragile; error correction codes are needed to protect the information stored in a quantum object from the deteriorating effects of noise. Quantum physicists in Innsbruck have developed a protocol to pass quantum information between differently encoded building blocks of a future quantum computer, such as processors and memories. Scientists may use this protocol in the future to build a data bus for quantum computers. The researchers have published their work in the journal Nature Communications.
Future quantum computers will be able to solve problems where conventional computers fail today. We are still far away from any large-scale implementation,...
15.11.2017 | Event News
15.11.2017 | Event News
30.10.2017 | Event News
21.11.2017 | Physics and Astronomy
21.11.2017 | Physics and Astronomy
21.11.2017 | Life Sciences