Endoscopy in the treatment of benign biliary strictures.

Background/aims: Operative endoscopy is now the method of choice for treating numerous biliary tree diseases. In the treatment of benign strictures of the biliary tree, endoscopy serves as an alternative to surgical interventions. We evaluated the efficacy of endoscopic biliary stents in the treatment of benign biliary strictures.

Patients: Fifty-three consecutive patients with benign strictures of the biliary tree underwent endoscopic placement of one or more 10-12 Fr endoprostheses. Thirty-nine patients (73.6%) had iatrogenic strictures and 14 had inflammatory strictures (in 8 patients due to gallstones and in 6, chronic pancreatitis). Of the 53 patients, 20 (37.7%) had strictures classified as Bismuth type I, 23 (43.3%) Bismuth type II, 7 (13.2%) Bismuth type III and 3 (5.7%) Bismuth type IV.

Results: None of the patients died during the study period; three patients (5.6%) had immediate endoscopy-related complications treated conservatively. Late complications developed in 47.1% of the patients: 11.3% had cholangitis amenable to medical therapy, 5.6% had dislodged endoprostheses and 30.2% had obstructed endoprostheses. The reason why blocked stents accounted for most of the long-term complications in this series was that endoprostheses were not changed electively: they were changed only when clinical and laboratory signs indicated obstruction. Follow-up (6-84 months) in 42 of the 56 patients. 20 after stent removal, showed that 71.4% had an excellent outcome, 14.3% good results and 14.3% needed surgery.

Conclusion: In benign biliary stricture endoscopic stenting is the first approach, providing definitive treatment or preparing patients for surgery.