Postoperative Biliary Strictures: The Endoscopic Approach

Abstract

Postoperative biliary strictures usually present with jaundice and/or cholangitis. Surgical reconstruction of these mostly proximal strictures is often associated with high morbidity and mortality. In addition, restenosis after surgery is common. We attempted endoscopic therapy in 63 consecutive patients with benign biliary strictures, by the placement of one or multiple 10 French endoprostheses. The procedure was successful in 54 out of 63 (86%) patients. All 54 had rapid clearance of jaundice and/ or cholangitis. Follow-up study during a median period of 32.5 (range, 1-96) months after stent removal of 35 patients showed 4 recurrent strictures and 5 recurrent stones. There was low morbidity and mortality associated with the procedures. Although placement of an endoprosthesis in this group of patients is technically difficult, we believe it should be considered as the initial therapeutic modality. The stents should preferably be multiple and left in situ for 1 year to avoid restenosis.

Key Words:

• Biliary endoprostheses
• endoscopic retrograde cholangiopancreatography
• postoperative biliary strictures