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!
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
Staphylococcus aureus is a feared pathogen (MRSA, multi-resistant S. aureus) due to frequent resistances against many antibiotics, especially in hospital infections. Researchers at the Paul-Ehrlich-Institut have identified immunological processes that prevent a successful immune response directed against the pathogenic agent. The delivery of bacterial proteins with RNA adjuvant or messenger RNA (mRNA) into immune cells allows the re-direction of the immune response towards an active defense against S. aureus. This could be of significant importance for the development of an effective vaccine. PLOS Pathogens has published these research results online on 25 May 2017.
Staphylococcus aureus (S. aureus) is a bacterium that colonizes by far more than half of the skin and the mucosa of adults, usually without causing infections....
Physicists from the University of Würzburg are capable of generating identical looking single light particles at the push of a button. Two new studies now demonstrate the potential this method holds.
The quantum computer has fuelled the imagination of scientists for decades: It is based on fundamentally different phenomena than a conventional computer....
An international team of physicists has monitored the scattering behaviour of electrons in a non-conducting material in real-time. Their insights could be beneficial for radiotherapy.
We can refer to electrons in non-conducting materials as ‘sluggish’. Typically, they remain fixed in a location, deep inside an atomic composite. It is hence...
Two-dimensional magnetic structures are regarded as a promising material for new types of data storage, since the magnetic properties of individual molecular building blocks can be investigated and modified. For the first time, researchers have now produced a wafer-thin ferrimagnet, in which molecules with different magnetic centers arrange themselves on a gold surface to form a checkerboard pattern. Scientists at the Swiss Nanoscience Institute at the University of Basel and the Paul Scherrer Institute published their findings in the journal Nature Communications.
Ferrimagnets are composed of two centers which are magnetized at different strengths and point in opposing directions. Two-dimensional, quasi-flat ferrimagnets...
An Australian-Chinese research team has created the world's thinnest hologram, paving the way towards the integration of 3D holography into everyday...
24.05.2017 | Event News
23.05.2017 | Event News
22.05.2017 | Event News
26.05.2017 | Life Sciences
26.05.2017 | Life Sciences
26.05.2017 | Physics and Astronomy