Eminler Ahmet Tarik, Koksal Aydin Seref, Toka Bilal, Karacaer Cengiz, Uslan Mustafa İhsan, Parlak Erkan
Faculty of Medicine, Department of Gastroenterology, Korucuk Campus, Sakarya University, Sakarya, Turkey.
Sakarya Training and Research Hospital, Gastroenterology, Sakarya, Turkey.
Surg Endosc. 2023 Apr;37(4):2587-2594. doi: 10.1007/s00464-022-09753-2. Epub 2022 Nov 8.
There are limited data about the benign biliary strictures (BBS) which can develop during the clinical course of acute biliary pancreatitis (ABP) due to compression of the common bile duct (CBD) by edematous and inflamed pancreatic tissue. We aimed to determine the incidence of BBS due to ABP and its clinical course after endoscopic management.
The study was retrospectively conducted among patients with ABP who were admitted to a single tertiary reference center during 3 years. BBS-ABP was defined as distal narrowing of the CBD with proximal dilatation and delayed drainage of the contrast into the duodenum. Endoscopic treatment was performed by inserting a single 7F or 10F plastic stent which was exchanged every 3 months until stricture resolution. Patients were followed for 1 year after stricture resolution.
Seven hundred and twenty-one patients had ABP during the study period. Among them, 257 (35.6%) patients underwent ERCP and 26 patients (3.6%) had CBD stricture due to ABP. A 7 Fr plastic stent was inserted in 18 patients and 10 Fr in 8 patients. The stricture was completely resolved at 3 months in 66.7%, at 6 months 23.8% and at 9 months (9.5%) of the patients. There was no procedure-related complications other than asymptomatic stent migration in 4 (19%) patients. None of the patients had recurrent biliary stricture during the 1 year stent-free follow-up period.
BBS-ABP is a frequently seen clinical entity. In most patients, the stricture improves within 3 months and temporary endoscopic stenting prevents the patients from the consequences of the obstruction during this period.
关于良性胆管狭窄（BBS）的数据有限，其可在急性胆源性胰腺炎（ABP）临床过程中因水肿和发炎的胰腺组织压迫胆总管（CBD）而发生。我们旨在确定ABP所致BBS的发生率及其内镜治疗后的临床病程。
本研究对3年间入住单一三级转诊中心的ABP患者进行回顾性研究。BBS-ABP定义为CBD远端狭窄伴近端扩张以及造影剂延迟排入十二指肠。通过插入单个7F或10F塑料支架进行内镜治疗，每3个月更换一次，直至狭窄解除。狭窄解除后对患者随访1年。
研究期间721例患者发生ABP。其中，257例（35.6%）患者接受了内镜逆行胰胆管造影（ERCP），26例（3.6%）患者因ABP出现CBD狭窄。18例患者插入7F塑料支架，8例患者插入10F塑料支架。66.7%的患者在3个月时狭窄完全解除，23.8%在6个月时解除，9.5%在9个月时解除。除4例（19%）患者出现无症状支架移位外，无其他与操作相关的并发症。在1年的无支架随访期内，无一例患者出现复发性胆管狭窄。
BBS-ABP是一种常见的临床病症。在大多数患者中，狭窄在3个月内改善，临时内镜支架置入可在此期间防止患者出现梗阻后果。
