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Three-months duration of fully-covered metal stent for refractory dominant extra-hepatic biliary stricture among primary sclerosing cholangitis patients: efficacy and safety

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Abstract

Background

Dominant stricture (DS) is a main cause of complication among patients with Primary Sclerosing Cholangitis (PSC). Endoscopic treatment options include dilation and plastic stenting, each with its own benefits and drawbacks.

Aims

The aim of the current study is to assess the safety and efficacy of fully-covered metal stent (FCMS) in these patients.

Methods

A retrospective study of PSC patients with refractory DS, defined as strictures resistance to conventional therapy (balloon dilatation, plastic biliary stent insertion or both) and who underwent FCMS insertion for 3 months were included. The primary outcome was defined as clinical and laboratory improvement, while secondary outcomes were DS resolution upon stent removal and cholangiographic DS recurrence at 12-months after FCMS extraction.

Results

Twenty patients were enrolled from January 2016 through January 2020. Improvement in weakness and pruritus were seen in 80% and 35%, 75% and 65%, 75% and 35% of patients at 1–3 and 6 months following FCMS removal, respectively. Similarly, consistent improvement in all liver enzymes and total bilirubin were seen in up to 6 month following stent removal. Only one patient (5%) needed premature FCMS removal due to cholangitis 1 week after stent placement and 2 cases (10%) of stent related pancreatitis were encountered. At 3-months all remaining stents were softly removed. Cholangiographic DS resolution was demonstrated in 13 patients (65%) after stent removal at 3-months, and DS recurred in 4 patients (4/13 = 30.7%) at 12-months following stent removal. Notably, only proximal biliary DS location showed a trend for DS recurrence (OR 28.6, P = 0.06).

Conclusion

Temporary 3 months duration FCMS was feasible, safe and effective treatment option among patients with PSC related refractory DS.

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Abbreviations

DS:

Dominant stricture

PSC:

Primary biliary sclerosing

FCMS:

Fully-covered metal stent

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

ALP:

Alkaline phosphatase

GGT:

Gamma glutamyl transferase

TB:

Total bilirubin

DB:

Direct bilirubin

OR:

Odds ratio

CI:

Confidence interval

References

  1. Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ, American Association for the Study of Liver D (2010) Diagnosis and management of primary sclerosing cholangitis. Hepatology 51:660–678

    Article  CAS  Google Scholar 

  2. Bambha K, Kim WR, Talwalkar J, Torgerson H, Benson JT, Therneau TM, Loftus EV Jr, Yawn BP, Dickson ER, Melton LJ 3rd (2003) Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community. Gastroenterology 125:1364–1369

    Article  Google Scholar 

  3. Kingham JG, Kochar N, Gravenor MB (2004) Incidence, clinical patterns, and outcomes of primary sclerosing cholangitis in South Wales, United Kingdom. Gastroenterology 126:1929–1930

    Article  Google Scholar 

  4. Tischendorf JJ, Hecker H, Kruger M, Manns MP, Meier PN (2007) Characterization, outcome, and prognosis in 273 patients with primary sclerosing cholangitis: a single center study. Am J Gastroenterol 102:107–114

    Article  Google Scholar 

  5. Gotthardt DN, Rudolph G, Kloters-Plachky P, Kulaksiz H, Stiehl A (2010) Endoscopic dilation of dominant stenoses in primary sclerosing cholangitis: outcome after long-term treatment. Gastrointest Endosc 71:527–534

    Article  Google Scholar 

  6. Lindor KD, Kowdley KV, Harrison ME, American College of Group (2015) ACG clinical guideline: primary sclerosing cholangitis. Am J Gastroenterol 110:646–659

    Article  CAS  Google Scholar 

  7. Kaya M, Petersen BT, Angulo P, Baron TH, Andrews JC, Gostout CJ, Lindor KD (2001) Balloon dilation compared to stenting of dominant strictures in primary sclerosing cholangitis. Am J Gastroenterol 96:1059–1066

    Article  CAS  Google Scholar 

  8. Alkhatib AA, Hilden K, Adler DG (2011) Comorbidities, sphincterotomy, and balloon dilation predict post-ERCP adverse events in PSC patients: operator experience is protective. Dig Dis Sci 56:3685–3688

    Article  Google Scholar 

  9. Chapman RW, Arborgh BA, Rhodes JM, Summerfield JA, Dick R, Scheuer PJ, Sherlock S (1980) Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology. Gut 21:870–877

    Article  CAS  Google Scholar 

  10. European Society of Gastrointestinal E, European Association for the Study of the Liver, European Association for the Study of the Liver (2017) Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. J Hepatol 66:1265–1281

    Article  Google Scholar 

  11. Ponsioen CY, Lam K, van Milligen de Wit AW, Huibregtse K, Tytgat GN (1999) Four years experience with short term stenting in primary sclerosing cholangitis. Am J Gastroenterol 94:2403–2407

    Article  CAS  Google Scholar 

  12. Aljiffry M, Renfrew PD, Walsh MJ, Laryea M, Molinari M (2011) Analytical review of diagnosis and treatment strategies for dominant bile duct strictures in patients with primary sclerosing cholangitis. HPB (Oxford) 13:79–90

    Article  Google Scholar 

  13. van Milligen de Wit AW, Rauws EA, van Bracht J, Mulder CJ, Jones EA, Tytgat GN, Huibregtse K (1997) Lack of complications following short-term stent therapy for extrahepatic bile duct strictures in primary sclerosing cholangitis. Gastrointest Endosc 46:344–347

    Article  Google Scholar 

  14. Ponsioen CY, Arnelo U, Bergquist A, Rauws EA, Paulsen V, Cantu P, Parzanese I, De Vries EM, van Munster KN, Said K, Chazouilleres O, Desaint B, Kemgang A, Farkkila M, Van der Merwe S, Van Steenbergen W, Marschall HU, Stotzer PO, Thorburn D, Pereira SP, Aabakken L (2018) No superiority of stents vs balloon dilatation for dominant strictures in patients with primary sclerosing cholangitis. Gastroenterology 155:752–759

    Article  Google Scholar 

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Author notes

  1. Wisam Sbeit and Tawfik Khoury have contributed equally to the work.

Authors and Affiliations

  1. Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel

    Wisam Sbeit & Tawfik Khoury

  2. Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel

    Wisam Sbeit & Tawfik Khoury

  3. Department of Gastroenterology and Liver Diseases, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel

    Eran Goldin & Mahmud Mahamid

Authors
  1. Wisam Sbeit
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  2. Tawfik Khoury
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  3. Eran Goldin
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  4. Mahmud Mahamid
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Contributions

EG and MM contributed to study design and concept. MM, TK and WS contributed to data collection and analysis. TK and WS wrote the draft of the manuscript. All authors approved the manuscript to be published.

Corresponding author

Correspondence to Tawfik Khoury.

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Disclosures

Wisam Sbeit, Tawfik Khoury, Eran Goldin and Mahmud Mahamid have no conflicts of interest or financial ties to disclose.

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Sbeit, W., Khoury, T., Goldin, E. et al. Three-months duration of fully-covered metal stent for refractory dominant extra-hepatic biliary stricture among primary sclerosing cholangitis patients: efficacy and safety. Surg Endosc 36, 2412–2417 (2022). https://doi.org/10.1007/s00464-021-08522-x

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  • DOI: https://doi.org/10.1007/s00464-021-08522-x

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