Are Expandable Metallic Stents Better Than Conventional Methods for Treating Difficult Intrahepatic Biliary Strictures With Recurrent Hepatolithiasis?

Abstract

Background: Conventional methods for treating patients with recurrent hepatolithiasis associated with complicated intrahepatic biliary strictures include balloon dilatation of the intrahepatic biliary strictures, lithotripsy, and the clearance of difficult stones as completely as possible, with the placement of an external-internal stent for at least 6 months. After these modalities are used, symptomatic refractory strictures remain. Recently we used internal Gianturco-Rosch metallic Z stents to treat patients who had refractory strictures. Objective: To compare therapeutic results and complications of an internal expandable metallic Z stent with those of repeated external-internal stent placement.

Resección hepática en el tratamiento de la litiasis intrahepática: Resultados inmediatos y a largo plazo en una serie occidental

“…Este último puede efectuarse bajo control radioló-gico percutáneo (colangioscopia transhepática percutánea, abordaje a través del tubo en T y otras) o endoscópico con o sin litroticia asociada (3,12,16,29,31,32). El tratamiento quirúrgico de los cálculos se puede realizar a través de una (4,(5)(6)(7)(8)12,15,17,19,24,26,27,(33)(34)(35).…”

Indications and therapeutical options in hepatolithiasis

“…Recurrence can cause suppurative cholangitis, hepatic abscesses, sepsis and multiple organ failure (20). Its treatment is complex (20).…”

“…Recurrence can cause suppurative cholangitis, hepatic abscesses, sepsis and multiple organ failure (20). Its treatment is complex (20). Re-operation is difficult due to the adhesions of previous surgery, the distortion of the biliary anatomy, and the scarring of the common bile duct,; as well as the patient's general condition and changes in hepatic function (20).…”

“…Re-operation is difficult due to the adhesions of previous surgery, the distortion of the biliary anatomy, and the scarring of the common bile duct,; as well as the patient's general condition and changes in hepatic function (20). For all these reasons, the use of minimally invasive techniques has increased in the past decade (20). If prostheses are used, it appears that metallic prostheses obtain better results than internal-external drainages (18).…”

Hepaticojejunostomy Anastomotic Strictures

“…The rationale of using metallic wall-stent would be to allow limiting the number of procedures and decrease hospital stays [47]. However, despite initial promising results and high primary technical success rates [48,49], long-term results of benign biliary stricture treatments by metallic stents have been tempered by high rates of late re-occlusion [50].…”