Department of Medicine, University of Heidelberg, Heidelberg, Germany.
Gastrointest Endosc. 2010 Mar;71(3):527-34. doi: 10.1016/j.gie.2009.10.041.
Primary sclerosing cholangitis is characterized by progressive fibrotic inflammation and obliteration of intra- and/or extrahepatic bile ducts. Total or subtotal stenoses of major bile ducts are associated with reduced survival.
To evaluate the outcome after long-term endoscopic treatment.
Prospective, single-center study.
Tertiary care academic medical center.
A total of 171 patients treated with ursodeoxycholic acid were followed for as long as 20 years. At entry, 20 patients had dominant stenoses, and during a median follow-up period of 7.1 years, dominant stenosis developed in another 77.
Ninety-six patients with dominant stenoses were treated by repeated balloon dilation; 5 patients with complete obstruction with bacterial cholangitis were stented.
Survival free of liver transplantation, number of procedures, complications.
In total, 500 balloon dilations were performed and 5 stents were placed. Complications were pancreatitis (2.2%), bacterial cholangitis (1.4%), and bile duct perforation (0.2%); there were no deaths. Repeated endoscopic interventions allowed the preservation of a functioning common bile duct and of at least 1 hepatic duct up to 2 cm above the bifurcation in all patients. Progression of intrahepatic bile duct and liver disease led to the need for liver transplantation in 22 of 96 patients. Five years after the first dilation of a dominant stenosis, the survival free of liver transplantation rate was 81%, and after 10 years, it was 52%.
Single-center study, no control group, primary end-stage liver disease excluded.
Repeated endoscopic balloon dilations of dominant stenoses allow the preservation of a functioning common bile duct for many years.
原发性硬化性胆管炎的特征是进行性纤维炎症和肝内外胆管闭塞。主要胆管的完全或部分狭窄与生存率降低有关。
评估长期内镜治疗的结果。
前瞻性、单中心研究。
三级保健学术医疗中心。
171 例患者接受熊去氧胆酸治疗，随访时间长达 20 年。入组时，20 例患者有主导性狭窄，中位随访期为 7.1 年，另外 77 例患者出现主导性狭窄。
96 例主导性狭窄患者行反复球囊扩张；5 例因细菌性胆管炎完全梗阻的患者行支架置入。
肝移植无生存、手术次数、并发症。
共进行了 500 次球囊扩张和 5 次支架置入。并发症为胰腺炎（2.2%）、细菌性胆管炎（1.4%）和胆管穿孔（0.2%）；无死亡病例。反复内镜介入使所有患者的胆总管和至少 1 条位于分叉上方 2cm 内的肝内胆管保持功能。肝内胆管和肝病的进展导致 96 例患者中有 22 例需要进行肝移植。首次扩张主导性狭窄后 5 年，无肝移植生存率为 81%，10 年后为 52%。
单中心研究，无对照组，排除原发性终末期肝病。
反复进行主导性狭窄的内镜球囊扩张可使胆总管功能保持多年。
