Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2017; 9(1): 12-18
Published online Jan 16, 2017. doi: 10.4253/wjge.v9.i1.12
Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis
Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi
Hiroshi Ohyama, Rintaro Mikata, Takeshi Ishihara, Yuji Sakai, Harutoshi Sugiyama, Shin Yasui, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan
Author contributions: Ohyama H, Mikata R and Ishihara T designed research; Ohyama H, Mikata R, Ishihara T, Sakai Y, Sugiyama H, Yasui S and Tsuyuguchi T acquired the data; Ohyama H and Mikata R analyzed and interpreted of data; Ohyama H drafted of the manuscript; Ohyama H, Mikata R and Ishihara T made critical revisions related to important intellectual content of the manuscript; Ohyama H, Mikata R, Ishihara T, Sakai Y, Sugiyama H, Yasui S and Tsuyuguchi T made final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Chiba University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts to disclose. All authors disclosed no financial relationships relevant to this publication.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rintaro Mikata, MD, PhD, Assistant Professor of Medicine, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana1-8-1, Chuo Ward, Chiba 260-8677, Japan. rinta48@yahoo.co.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: June 24, 2016
Peer-review started: June 24, 2016
First decision: August 10, 2016
Revised: August 25, 2016
Accepted: November 1, 2016
Article in press: November 3, 2016
Published online: January 16, 2017
Processing time: 193 Days and 9.8 Hours
Abstract
AIM

To investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors.

METHODS

Ten consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared.

RESULTS

Endoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo.

CONCLUSION

Sequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy.

Keywords: Chronic pancreatitis; Biliary stricture; Biliary stent; Pancreatic stone; Endoscopy

Core tip: Endoscopic biliary stenting for benign biliary strictures (BBS) is useful for symptom relief and less invasive than surgery. Therefore, BBS caused by chronic pancreatitis (CP) is often managed by biliary stenting. However, subsequent treatment for refractory BBS caused by CP is unclear and no predictive factors for therapeutic success have been defined. The results of the present study indicated that endoscopic therapy with multiple biliary stenting was effective against the refractory BBS caused by chronic calcifying pancreatitis. Moreover, our study indicated that stricture length was correlated with therapeutic outcome.