Endotherapy of postcholecystectomy biliary strictures with multiple plastic stents: long-term results in a large cohort of patients

BACKGROUND AND AIMS: Endoscopic therapy of benign biliary strictures (BBSs) with multiple plastic stent (MPS) placement has shown satisfactory results. However, literature describes various BBS etiologies. Aim of this study was to evaluate long-term MPS results in patients with postcholecystectomy biliary strictures (PCBSs). METHODS: PCBS patients without complete bile duct transection were included. ERCP consisted of placing an increasing plastic stent number over time, exchanged at regular intervals (3-4 months), until complete morphologic stricture disappearance. After stent removal, patient follow-up comprised liver function tests (LFTs) and clinical assessment. RESULTS: One hundred fifty-four patients (43.5% males; mean age 53 years) were enrolled; in 43% of the cases, PCBSs were involved or were close to the main hepatic confluence. PCBS resolution rate was 96.7% (n=149). A mean maximum number of 4.3 ± 1.6 stents were placed side-by-side; a mean of 4.2 ± 1.5 ERCPs per patient was needed to obtain PCBS resolution during a mean treatment period of 11.8 ± 6.4 months. Unscheduled stent exchange due to cholangitis, jaundice or pain occurred in 7.4% of cases. Procedure-related mortality was absent. Follow-up data were available in 85.2% of cases. After a mean follow-up of 11.1 ± 4.9 years, stricture recurrence rate was 9.4% (n=12). Subsequent to re-treatment, 83.3% (n=10) of patients were asymptomatic after a mean time of 9 years, whereas 2 patients underwent hepaticojejunostomy due to failed re-treatment. Statistical analysis revealed no risk factors for PCBS recurrence after MPS. CONCLUSIONS: Endoscopic therapy of PCBSs with MPSs is safe and effective at long-term follow-up. PCBSs involving or being close to the main hepatic confluence were successfully treated with MPSs. PCBS recurrence rate is low and can be successful endoscopically retreated without precluding possible surgical treatment.