Bile duct stents in the management of hepatolithiasis with long-segment intrahepatic biliary strictures

Abstract

Biliary stricture represents a challenging problem in the treatment of hepatolithiasis because of its association with treatment failure and stone recurrence. The long-segment type of stricture is difficult to manage and is likely to recur. To investigate the necessity for biliary stenting after balloon dilatation therapy, 20 consecutive patients with long-segment strictures who had 22 stents (group 1) were compared with ten patients who refused stenting (group 2). The long-segment strictures in group 1 were located on the right side in 80 per cent of patients, on the left side in 10 per cent, and were bilateral in 10 per cent. The stents, varying from 8 to 12 Fr, were retained for at least 6 months. They were inserted through the routes of a matured T tube track (five cases), percutaneous transhepatic track (14 cases), a jejunal limb (two cases) and a fistula (one case). Complications of stenting consisted of dislodgement (one case), haemobilia (two cases), cholangitis (two cases) and intrahepatic abscess (one case). The cumulative probability of stricture recurrence in group 1 was 10 per cent, 15 per cent and 21 per cent at 2, 3 and 4 years, respectively, whereas in group 2 it was 80 per cent at 2 years (P less than 0.003). The results suggest that intrahepatic biliary stenting after balloon dilatation appears necessary and helpful in the management of hepatolithiasis with long-segment biliary strictures.

Suppression of proliferative cholangitis in a rat model with direct adenovirus-mediated retinoblastoma gene transfer to the biliary tract

“…3,4,15 It develops biliary strictures, bile duct wall thickness, bile retention, and suppurative cholangitis. 3,4 It is the main cause of residual and recurrent stones, [1][2][3][5][6][7]15 which are the most difficult problems in hepatolithiasis treatments. [1][2][3] A number of hepatolithiasis treatment options, including surgical procedures like choledochotomy, hepaticojejunostomy, hepatectomy, and papilloplasty, have been performed.…”

“…[1][2][3]16,20,21 As well, the restenosis rate after biliary strictures had been successfully dilated using the balloon dilatation method was 24% to 58% during a follow-up period of 3 to 7.5 years. [5][6][7]18,19,22 Thus, because these kinds of treatment options have failed to significantly reduce the rates of the residual and recurrent stones following them, some additional or supportive strategies have been required for reducing those rates.…”

“…[1][2][3][4][5] The most characteristic pathological feature is proliferative cholangitis (PC), which shows the peribiliary gland hyperplasia and the proliferation of the biliary epithelium and fibrous tissue, resulting in considerable thickening of the bile duct wall. [3][4][5] PC frequently induces residual and/or recurrent stones, [1][2][3][5][6][7] which are the largest problem after repeated treatments for hepatolithiasis. [1][2][3] In the present study, gene therapy using the adenovirus vector encoding nonphosphorylatable, constitutively active form of retinoblastoma gene product (AdRb) was introduced to reduce proliferation caused by PC.…”

“…Cholestasis and biliary infection are considered to play important roles in the formation of intrahepatic stones and to remain even after treatments for hepatolithiasis. [1][2][3][5][6][7] We assumed that inhibition of the formation of proliferative changes in this model could lead to some new adjuvant treatment modality for reducing recurrence of PC and stones after treatments. Therefore, we investigated in the current study whether the adenovirus-mediated overexpression of human Rb into the biliary tract could control the formation of proliferative changes in this model.…”

Bilateral liver resection for bilateral intrahepatic stones

“…The Cox proportional hazards model indicated that a liver resection range less than the range of stone distribution was the only independent risk factor associated with stone recurrence in this study. A liver resection range less than the range of stone distribution may leave bile duct stricture, which is a key predisposing factor for stone recurrence [9][10][11] . There is reluctance among some surgeons to perform bilateral liver resection for bilobar stones because of the associated surgical risks.…”