Many Remain Stent Free Years After Temporary Stent Placement for Benign Biliary Strictures

By Reuters Staff

September 23, 2019

NEW YORK (Reuters Health) - Most patients remain stent free five years after temporary placement of stents for benign biliary strictures secondary to chronic pancreatitis, researchers report.

Endoscopic stent placement is frequently used to treat benign biliary strictures associated with chronic pancreatitis. Fully covered self-expanding metal stents (FCSEMSs) provide larger lumens than do plastic stents, which require stent exchanges every few months.

Earlier, Dr. Jacques Deviere of Universite Libre de Bruxelles, in Brussels, and colleagues in the Benign Biliary Stenosis Working Group reported that FCSEMSs with planned removal at 10 to 12 months was associated with only a 10.5% probability of stricture recurrence at 18 months.

In the current study, they evaluated five-year follow-up results to determine the durability of common bile-duct stricture resolution in 118 patients with chronic pancreatitis-associated benign biliary strictures.

Median duration of the stent placement period was 342.5 days for the 108 patients who had endoscopic stent removal (13 before 10 months and 95 at 10 to 12 months after the index procedure).

At 75 months after FCSEMS placement, 61.6% of patients were stent free. And at five years after the end of FCSEMS indwell, 77.4% of the 94 patients who had stricture resolution at endoscopic stent removal or at observation of complete distal migration of the stent out of the common bile duct remained stent free.

Severity of chronic pancreatitis and stricture length were significant predictors of stricture recurrence, the researchers report in Gastrointestinal Endoscopy, online September 5.

At five years after stent removal, 53 of 56 evaluable patients were free of symptoms of biliary obstruction and/or cholestasis; the other three evaluable patients were free of biliary obstructive symptoms at their 48-month study visit but five-year symptom data were missing.

Overall, 22.9% of patients experienced serious adverse events related to the stent, its removal, or both, most commonly cholangitis (9.3%).

"Taken together, the data presented here support the role of an endoscopic biliary drainage with FCSEMS placement as a first therapeutic approach for chronic pancreatitis-associated symptomatic benign biliary stricture," the researchers conclude. "Patients who fail stricture resolution after 1 year indwell should still be considered for surgery."

Boston Scientific, manufacturer of the stent used in this study, participated in the study design, collection and analysis of data, and drafting of the report. Several authors report ties to the company.

Dr. Deviere was not available for comments.

SOURCE: https://bit.ly/2m3oCwI

Gastrointest Endosc 2019.

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