RESULTS OF ENDOSCOPIC TREATMENT OF POSTTRAUMATIC BILIARY STRICTURES

Background. Intraoperative bile duct injury is a serious and potentially life-threatening complication in post-operative period. The treatment of surgical trauma is complex and multiple. The incidence of disability is up to 50 % and duration of treatment is up to 42 weeks. Objective. To estimate the feasibilities of endoscopic treatment of iatrogenic biliary strictures. Material and methods. The series of 19 patients underwent endoscopic treatment of iatrogenic biliary strictures in a period from 2014 to 2017. Treatment protocol included: ERCP, balloon and bougie dilation of strictures followed by stenting with several plastic stents or stenting with one full cover metallic stent. After primary endoscopic procedure all patients underwent step-wise restenting procedures with increasing number of plastic stents. Results. The technical success rate of endoscopic procedures is 100 %. The step-wise endoscopic stenting was completed in 12 out of 16 followed-up patients. The clinical success rate which imlicates full release of the stricture was in 12 out of 12 patients with complete endoscopic treatment. The intraoperative complication included bleeding in one patient, which required stenting with SEMS for hemostasis. The late postoperative complication included new stricture at the upper level was observed in two patients. The recurrent choledoholithiasis was observed in one patients. Conclusion. Endoscopic procedures are effective and safe treatment option for iatrigenic biliary strictures, but more prolonged studies are needed for appropriate assessment of the long-term results.

ERCP, endoscopic treatment, iatrogenic strictures, posttraumatic strictures, strictures of bile ducts, stenting, plastic stents, metal stents, complications

1. de Reuver P. R., Sprangers M. A., Rauws E. A. et al. Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment. // Endoscopy, 2008. 40(8): p. 637-43.

2. Walsh R.M., Henderson J. M., Vogt D. P., Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. // Surgery, 2007. 142(4): p. 450-6; discussion 456-7.

3. Calvete J., Sabater L., Camps B. et al. Bile duct injury during laparoscopic cholecystectomy: myth or reality of the learning curve? // Surg Endosc, 2000. 14(7): p. 608-11.

4. Misra M., Schiff J., Rendon G. et al. Laparoscopic cholecystectomy after the learning curve: what should we expect? // Surg Endosc, 2005. 19(9): p. 1266-71.

5. Perera M.T., Monaco A., Silva M. A. et al. Laparoscopic posterior sectoral bile duct injury: the emerging role of nonoperative management with improved long-term results after delayed diagnosis. // Surg Endosc, 2011. 25(8): p. 2684-91.

6. Deziel D.J., Millikan K. W., Economou S. G. et al. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. // Am J Surg, 1993. 165(1): p. 9-14.

7. Vecchio R., MacFadyen B.V., Latteri S. Laparoscopic cholecystectomy: an analysis on 114,005 cases of United States series. // Int Surg, 1998. 83(3): p. 215-9.

8. Adamsen S., Hansen O. H., Funch-Jensen P. et al. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. // J Am Coll Surg, 1997. 184(6): p. 571-8.

9. Nuzzo G., Giuliante F., Giovannini I. et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. // Arch Surg, 2005. 140(10): p. 986-92.

10. Harboe K.M., Bardram L. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. // Surg Endosc, 2011. 25(5): p. 1630-41.

11. Waage A., Nilsson M. Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. // Arch Surg, 2006. 141(12): p. 1207-13.

12. The Southern Surgeons Club, A prospective analysis of 1518 laparoscopic cholecystectomies. // N Engl J Med, 1991. 324(16): p. 1073-8.

13. Tantia O., Jain M., Khanna S., Sen B. Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years. // Surg Endosc, 2008. 22(4): p. 1077-86.

14. Stewart L. Iatrogenic biliary injuries: identification, classification, and management. // Surg Clin North Am, 2014. 94(2): p. 297-310.

15. Landman M.P., Feurer I. D., Moore D. E. et al. The long-term effect of bile duct injuries on health-related quality of life: a meta-analysis. // HPB (Oxford), 2013. 15(4): p. 252-9.

16. Thompson C.M., Saad N. E., Quazi R. R. et al. Management of iatrogenic bile duct injuries: role of the interventional radiologist. // Radiographics, 2013. 33(1): p. 117-34.

17. Pausawasadi N., Soontornmanokul T., Rerknimitr R. Role of fully covered self-expandable metal stent for treatment of benign biliary strictures and bile leaks. // Korean J Radiol, 2012. 13 Suppl 1: p. S 67-73.

18. Strasberg S.M., Hertl M., Soper N. J. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. // J Am Coll Surg, 1995. 180(1): p. 101-25.

19. Гальперин Э.И., Чевокин.А.Ю. Факторы, определяющие выбор операции при «свежих» повреждениях магистральных желчных протоков. // Анналы хирургической гепатологии, 2009. 14(1): p. 49-56.

20. Cote G.A., Slivka A., Tarnasky P. et al. Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution: A Randomized Clinical Trial. // JAMA, 2016. 315(12): p. 1250-7.

21. Haapamaki C., Kylänpää L., Udd M. et al. Randomized multicenter study of multiple plastic stents vs. covered self-expandable metallic stent in the treatment of biliary stricture in chronic pancreatitis. // Endoscopy, 2015. 47(7): p. 605-10.

22. van Boeckel P. G., Vleggaar F. P., Siersema P. D. Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. // BMC Gastroenterol, 2009. 9: p. 96.

23. Dumonceau J.M., Tringali A., Blero D. et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. // Endoscopy, 2012. 44(3): p. 277-98.

24. Park J.S., Lee S. S., Song T. J. et al. Long-term outcomes of covered self-expandable metal stents for treating benign biliary strictures. // Endoscopy, 2016. 48(5): p. 447.

25. Kaffes A.J. Management of benign biliary strictures: current status and perspective. //J Hepatobiliary Pancreat Sci, 2015. 22(9): p. 657-63.

26. Poley J.W., Cahen D. L., Metselaar H. J. et al. A prospective group sequential study evaluating a new type of fully covered self-expandable metal stent for the treatment of benign biliary strictures. // Gastrointest Endosc, 2012. 75(4): p. 783-9.

27. Глебов К.Г., Котовский.А.Е., Дюжева Т. Г. Критерии выбора конструкции эндопротеза для эндоскопического стентирования желчных протоков. // Анналы хирургической гепатологии, 2014. 2(19): p. 55-65.

28. Baillie J. Clinical trial report: endoscopic treatment of postoperative bile duct strictures using multiple stents: long-term results. // Curr Gastroenterol Rep, 2011. 13(2): p. 114-6.