Management of Benign Biliary Stricture in Chronic Pancreatitis - 13/09/23

Doi : 10.1016/j.giec.2023.04.002

Mohan Ramchandani, MD, DM ^a,^b,^⁎ , Partha Pal, MD, DNB, MRCP (UK) ^a, Guido Costamagna, MD ^c
^a Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, Telangana, India
^b Interventional Endoscopy, AIG Hospitals, Plot No 2/3/4/5 Survey, 1, Mindspace Road, Gachibowli, Hyderabad, Telangana 500032, India
^c Department of Translational Medicine and Surgery, Catholic University, Rome

^∗Corresponding author. Interventional Endoscopy, AIG hospitals, Plot No 2/3/4/5 Survey, 1, Mindspace Road, Gachibowli, Hyderabad, Telangana 500032, India.Interventional EndoscopyAIG hospitalsPlot No 2/3/4/5 Survey1, Mindspace RoadGachibowliHyderabadTelangana500032India

Résumé

Endoscopic therapy is the first line of management for chronic pancreatitis (CP)-related benign biliary strictures. Multiple plastic stents (MPS) exchanged at regular intervals and temporary placement of fully covered self-expanding metal stents (FCSEMS) are preferred modalities of endotherapy. FCSEMS placement is non-inferior to MPS and requires fewer sessions of endoscopic retrograde cholangiopancreatography than MPS placement. The presence of head calcifications, severe CP, and length of stricture are predictors of failure or recurrence after endotherapy. Failure of endotherapy should be considered after 1 year when surgery should be considered.

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Keywords : Chronic pancreatitis, Endoscopic retrograde cholangiopancreatography, Benign biliary stricture, Plastic stent, Self-expandable metal stent, Surgery