Clinical Use of Gianturco Expandable Metallic Stent in Benign Biliary Stricture: Result of Longterm Follow-up

Baek, Young Ki; So, Byung Jun; Chae, Kwon Mook; Noh, Byung Suk

Abstract

BACKGROUND: Self-expandable metallic stent is an effective method in palliative treatment of malignant biliary stricture. However, it is controvesial in benign biliary stricture due to recurrent jaundice, cholangtitis, and finally, obstruction of stent. The purpose of this study was to determine the long-term effectiveness of Gianturco expandable metallic stents in benign biliary strictures.
METHODS
We inserted Gianturco self-expandable metallic stent in 13 patients (42~69 years old, 6 men and 7 women) with benign biliary stricture between November 1991 and September 1994 in Wonkwang University Hospital. All patients had a previous history of biliary surgery and underwent balloon dilatation procedure for management of strictures. Insertion routes were percutaneous transhepatic biliary drainage tracks in 8 cases and T-tube tracks in 5 cases. The insertion site was the right intrahepatic duct in 5 cases, the left intrahepatic duct in 2 cases, both intrahepatic ducts in 1 case, common hepatic duct in 1 case, and distal common bile ducts in 4 cases. The stents used were 2~6cm in length and 8~12mm in diameter. The follow-up period was 46months to 81months(mean, 67months).
RESULTS
The initial technical success rate was 100% with good immediate patency in all patients. Nine patients(69.2%) had no recurrence of the initial strictures during the follow-up period and 4 patients(30.7%) had further symptoms of biliary obstruction caused by recurrent cholangitis or intrahepatic duct stone formation. These 4 recurrent biliary strictures were treated by surgical methods. The recurrent stricture sites were distal common bile duct(1case), left intrahepatic duct(1case), both intrahepatic ducts(1case), and Roux-en-Y hepaticojejunostomy site(1case).
CONCLUSIONS
According to the results of long-term follow-up, expandable metallic stent is a useful method in recurrent biliary strictures, especially in the case where operation is not feasible; poor risk patients, patients refusing operation, multiple biliary operation.