Skip to main content

Advertisement

SpringerLink
Log in

A comparative study of surgery and endoscopy for the treatment of bile duct stricture in patients with chronic pancreatitis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to compare the outcomes of endoscopic treatment (ET) and surgical treatment (ST) for common bile duct (CBD) stricture in patients with chronic pancreatitis (CP).

Methods

From 2004 to 2009, 39 patients (35 men and 4 women; median age, 52 years; range, 38–66 years) were referred for CBD stricture in CP. Of these 39 patients, 33 (85 %) underwent primary ET, and 6 underwent primary ST. Treatment success was defined in both groups as the absence of signs denoting recurrence, with normal serum bilirubin and alkaline phosphatase levels after permanent stent removal in ET group. The follow-up period was longer than 12 months for all the patients.

Results

For the patients treated with ET, the mean number of biliary procedures was 3 (range, 1–10) per patient including extractible metallic stents in 35 % and multiple plastic stents in 65 % of the patients. The mean duration of stent intubation was 11 months. The surgical procedure associated with biliary drainage (4 choledochoduodenostomies, 1 choledochojejunostomy, and 1 biliary decompression within the pancreatic head) was a Frey procedure for five patients and a pancreaticojejunostomy for one patient. The overall morbidity rate was higher in the ST group. The total hospital length of stay was similar in the two groups (16 vs 24 days, respectively; p = 0.21). In terms of intention to treat, the success rates for ST and ET did not differ significantly (83 % vs 76 %; p = 0.08). Due to failure, 17 patients required ST after ET. Event-free survival was significantly longer in the ST group (16.9 vs 5.8 months; p = 0.01). The actuarial success rates were 74 % at 6 months, 74 % at 12 months, and 65 % at 24 months in the ST group and respectively 75 %, 69 %, and 12 % in the ET group (p = 0.01). After more than three endoscopic procedures, the success rates were 27 % at 6 months and 18 % at 18 months.

Conclusion

For bile duct stricture in CP, surgery is associated with better long-term outcomes than endoscopic therapy. After more than three endoscopic procedures, the success rate is low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ALP:

Alkaline phosphatase

CBD:

Common bile duct

CP:

Chronic pancreatitis

CT:

Computed tomography

ERCP:

Endoscopic retrograde cholangiopancreatography

ET:

Endoscopic therapy

SB:

Total serum bilirubin

ST:

Surgical therapy

MRI:

Magnetic resonance imaging

PP:

Per protocol

ITT:

Intention to treat

References

  1. Caroli J, Nora J (1952) L’hepato-choledoque dans les pancreatitis. Ille Congres Europeen des Societes Nationales de Gastroenterologie, Bologne

    Google Scholar 

  2. Yadegar J, Williams RA, Passaro E Jr, Wilson SE (1980) Common duct stricture from chronic pancreatitis. Arch Surg 115:582–586

    Article  PubMed  CAS  Google Scholar 

  3. Huizinga WK, Thomson SR, Spitaels JM, Simjee AE (1992) Chronic pancreatitis with biliary obstruction. Ann R Coll Surg Engl 74:119–123

    PubMed  CAS  Google Scholar 

  4. Sand JA, Nordback IH (1995) Management of cholestasis in patients with chronic pancreatitis: evaluation of a treatment protocol. Eur J Surg 161:587–592

    PubMed  CAS  Google Scholar 

  5. Bartoli E, Delcenserie R, Yzet T, Brazier F, Geslin G, Regimbeau JM, Dupas JL (2005) Endoscopic treatment of chronic pancreatitis. Gastroenterol Clin Biol 29:515–521

    Article  PubMed  Google Scholar 

  6. Vijungco JD, Prinz RA (2003) Management of biliary and duodenal complications of chronic pancreatitis. World J Surg 27:1258–1270

    Article  PubMed  Google Scholar 

  7. Beger HG, Büchler M, Bittner R, Uhl W (1990) Duodenum-preserving resection of the head of the pancreas: an alternative to Whipple’s procedure in chronic pancreatitis. Hepatogastroenterology 37:283–289

    PubMed  CAS  Google Scholar 

  8. Izbicki JR, Bloechle C, Knoefel WT, Wilker DK, Dornschneider G, Seifert H, Passlick B, Rogiers X, Busch C, Broelsch CE (1994) Complications of adjacent organs in chronic pancreatitis managed by duodenum-preserving resection of the head of the pancreas. Br J Surg 81:1351–1355

    Article  PubMed  CAS  Google Scholar 

  9. Kalvaria I, Bornman PC, Marks IN, Girdwood AH, Bank L, Kottler RE (1989) The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis. Ann Surg 210:608–613

    Article  PubMed  CAS  Google Scholar 

  10. Lesur G, Levy P, Flejou JF, Belghiti J, Fekete F, Bernades P (1993) Factors predictive of liver histopathological appearance in chronic alcoholic pancreatitis with common bile duct stenosis and increased serum alkaline phosphatase. Hepatology 18:1078–1081

    Article  PubMed  CAS  Google Scholar 

  11. Hammel P, Couvelard A, O’Toole D, Ratouis A, Sauvanet A, Fléjou JF, Degott C, Belghiti J, Bernades P, Valla D, Ruszniewski P, Lévy P (2001) Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct. N Engl J Med 344:418–423

    Article  PubMed  CAS  Google Scholar 

  12. Sarner M, Cotton PB (1984) Classification of pancreatitis. Gut 25:756–759

    Article  PubMed  CAS  Google Scholar 

  13. Lévy P, Barthet M, Mollard BR, Amouretti M, Marion-Audibert AM, Dyard F (2006) Estimation of the prevalence and incidence of chronic pancreatitis and its complications. Gastroenterol Clin Biol 30:838–844

    Article  PubMed  Google Scholar 

  14. Regimbeau JM, Dumont F, Yzet T, Chatelain D, Bartoli ER, Brazier F, Bréhant O, Dupas JL, Mauvais F, Delcenserie R (2007) Surgical management of chronic pancreatitis. Gastroenterol Clin Biol 31:672–685

    Article  PubMed  Google Scholar 

  15. Kahl S, Zimmermann S, Genz I, Glasbrenner B, Pross M, Schulz HU, Mc Namara D, Schmidt U, Malfertheiner P (2003) Risk factors for failure of endoscopic stenting of biliary strictures in chronic pancreatitis: a prospective follow-up study. Am J Gastroenterol 98:2448–2453

    Article  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  17. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M; International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Google Scholar 

  18. van Boeckel PG, Vleggaar FP, Siersema PD (2009) Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC Gastroenterol 17(9):96

    Article  Google Scholar 

  19. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE (1995) Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis: a prospective, randomized trial. Ann Surg 221:350–358

    Article  PubMed  CAS  Google Scholar 

  20. Pessaux P, Lada P, Etienne S, Tuech JJ, Lermite E, Brehant O, Triau S, Arnaud JP (2006) Duodenopancreatectomy for cystic dystrophy in heterotopic pancreas of the duodenal wall. Gastroenterol Clin Biol 30:24–28

    Article  PubMed  Google Scholar 

  21. Chaudhary A, Negi SS, Masood S, Thombare M (2004) Complications after Frey’s procedure for chronic pancreatitis. Am J Surg 188:277–281

    Article  PubMed  Google Scholar 

  22. Boerma D, van Gulik TM, Rauws EA, Obertop H, Gouma DJ (2002) Outcome of pancreaticojejunostomy after previous endoscopic stenting in patients with chronic pancreatitis. Eur J Surg 168:223–228

    Article  PubMed  Google Scholar 

  23. de Reuver PR, Rauws EA, Vermeulen M, Dijkgraaf MG, Gouma DJ, Bruno MJ (2007) Endoscopic treatment of postsurgical bile duct injuries: long-term outcome and predictors of success. Gut 56:1599–1605

    Article  PubMed  Google Scholar 

  24. Frey CF, Suzuki M, Isaji S (1990) Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg 14:59–69

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

Jean-Marc Regimbeau, David Fuks, Eric Bartoli, Mathurin Fumery, Adina Hanes, Thierry Yzet, and Richard Delcenserie have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    Jean-Marc Regimbeau, David Fuks & Adina Hanes

  2. Department of Hepatogastroenterology, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    Eric Bartoli, Mathurin Fumery & Richard Delcenserie

  3. Department of Radiology, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    Thierry Yzet

Authors
  1. Jean-Marc Regimbeau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Bartoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mathurin Fumery
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adina Hanes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thierry Yzet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard Delcenserie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Marc Regimbeau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Regimbeau, JM., Fuks, D., Bartoli, E. et al. A comparative study of surgery and endoscopy for the treatment of bile duct stricture in patients with chronic pancreatitis. Surg Endosc 26, 2902–2908 (2012). https://doi.org/10.1007/s00464-012-2283-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2283-7

Keywords

Search

Navigation