Gastroenterology Department, Cochin Hospital, Paris, France.
Endoscopy. 2011 Mar;43(3):208-16. doi: 10.1055/s-0030-1256106. Epub 2011 Mar 1.
Endoscopic stenting is a recognized treatment of postcholecystectomy biliary strictures. Large multicenter reports of its long-term efficacy are lacking. Our aim was to analyze the long-term outcomes after stenting in this patient population, based on a large experience from several centers in France.
Members of the French Society of Digestive Endoscopy were asked to identify patients treated for a common bile duct postcholecystectomy stricture. Patients with successful stenting and follow-up after removal of stent(s) were subsequently included and analyzed. Main outcome measures were long-term success of endoscopic stenting and related predictors for recurrence (after one stenting period) or failure (at the end of follow-up).
A total of 96 patients were eligible for inclusion. The mean number of stents inserted at the same time was 1.9±0.89 (range 1-4). Stent-related morbidity was 22.9% (n=22). The median duration of stenting was 12 months (range 2-96 months). After a mean follow-up of 6.4±3.8 years (range 0-20.3 years) the overall success rate was 66.7% (n=64) after one period of stenting and 82.3% (n=79) after additional treatments. The mean time to recurrence was 19.7±36.6 months. The most significant independent predictor of both recurrence and failure was a pathological cholangiography at the time of stent removal.
Endoscopic stenting helps to avoid surgery in more than 80% of patients bearing postcholecystectomy common bile duct strictures. However, a persistent anomaly on cholangiography at the time of stent removal is a strong predictor of recurrence and may lead to consideration of surgery.
内镜下支架置入术是治疗胆囊切除术后胆管狭窄的一种公认方法。目前缺乏关于其长期疗效的大型多中心报告。我们的目的是根据法国几个中心的大量经验，分析该患者人群内镜下支架置入后的长期结果。
法国消化内镜学会的成员被要求确定接受治疗的胆总管胆囊切除术后狭窄患者。成功进行支架置入并在移除支架后进行随访的患者随后被纳入并进行分析。主要观察指标是内镜下支架置入的长期成功率和与复发（在一个支架置入期后）或失败（在随访结束时）相关的预测因素。
共有 96 名患者符合纳入标准。同期置入的支架平均数量为 1.9±0.89（范围 1-4）。支架相关并发症发生率为 22.9%（n=22）。支架置入的中位时间为 12 个月（范围 2-96 个月）。在平均 6.4±3.8 年（范围 0-20.3 年）的随访后，单次支架置入后 66.7%（n=64）的总体成功率和追加治疗后 82.3%（n=79）的总体成功率。复发的平均时间为 19.7±36.6 个月。支架移除时病理胆管造影是复发和失败的最显著独立预测因素。
在患有胆囊切除术后胆总管狭窄的患者中，内镜下支架置入术有助于避免 80%以上的患者接受手术。然而，支架移除时胆管造影持续异常是复发的强烈预测因素，可能导致考虑手术。
