Gastroenterology Department, Cochin Hospital, Paris, France.
Public Health Department, Henri Mondor Hospital, LIC EA4393 Paris Est Créteil University (UPEC), Paris, France.
United European Gastroenterol J. 2016 Jun;4(3):403-12. doi: 10.1177/2050640615606550. Epub 2015 Sep 24.
Endoscopic treatment of benign biliary strictures (BBS) can be challenging.
To evaluate the efficacy of fully covered self-expandable metal stents (FCSEMS) in BBS.
Ninety-two consecutive patients with BBS (chronic pancreatitis (n = 42), anastomotic after liver transplantation (n = 36), and post biliary surgical procedure (n = 14)) were included. FCSEMS were placed across strictures for 6 months before endoscopic extraction. Early success rate was defined as the absence of biliary stricture or as a minimal residual anomaly on post-stent removal endoscopic retrograde cholangiopancreatography (ERCP). Secondary outcomes were the final success and stricture recurrence rates as well as procedure-related morbidity.
Stenting was successful in all patients. Stenting associated complications were minor and occurred in 22 (23.9%) patients. Migration occurred in 23 (25%) patients. Stent extraction was successful in all but two patients with proximal stent migration. ERCP after the 6 months stenting showed an early success in 84.9% patients (chronic pancreatitis patients: 94.7%, liver transplant: 87.9%, post-surgical: 61.5%) (p = 0.01). Final success was observed in 57/73 (78.1%) patients with a median follow-up of 12 ± 3.56 months. Recurrence of biliary stricture occurred in 16/73 (21.9%) patients.
FCSEMS placement is efficient for patients with BBS, in particular for chronic pancreatitis patients. Stent extraction after 6 months indwelling, although generally feasible, may fail in a few cases.
良性胆道狭窄（BBS）的内镜治疗具有挑战性。
评估全覆膜自膨式金属支架（FCSEMS）在 BBS 中的疗效。
共纳入 92 例 BBS 患者（慢性胰腺炎 42 例、肝移植后吻合口狭窄 36 例、胆道手术后狭窄 14 例）。在进行内镜下取出前，FCSEMS 被放置在狭窄部位 6 个月。早期成功率定义为胆管狭窄消失或支架取出后内镜逆行胰胆管造影（ERCP）显示最小残余异常。次要结局包括最终成功率、狭窄复发率和与操作相关的发病率。
所有患者均成功置管。支架相关并发症轻微，共发生于 22 例（23.9%）患者中。支架迁移发生于 23 例（25%）患者中。除了 2 例近端支架迁移的患者外，其余患者均成功取出支架。支架置入 6 个月后行 ERCP 显示，84.9%的患者（慢性胰腺炎患者：94.7%；肝移植患者：87.9%；手术后患者：61.5%）早期成功（p=0.01）。57/73（78.1%）例患者获得最终成功，中位随访时间为 12±3.56 个月。16/73（21.9%）例患者出现胆道狭窄复发。
FCSEMS 置入术对 BBS 患者有效，尤其对慢性胰腺炎患者效果显著。支架留置 6 个月后取出虽然通常可行，但在少数情况下可能会失败。
