Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Results of the placement of multiple endoscopic stents for postoperative biliary strictures remains excellent

22.09.2010
New study shows stricture recurrence rate is low and those that recur can be successfully retreated endoscopically

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.

Results

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.

About Endoscopy

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!
Further information:
http://www.asge.org

More articles from Studies and Analyses:

nachricht Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT

nachricht Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>