Biliary Stent Therapy for Dominant Strictures in Patients Affected by Primary Sclerosing Cholangitis

Abstract

The diagnosis and the treatment of dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the scientific literature on the subject is quite limited. Only level II and level III evidence is available to guide physicians managing patients with DS and PSC. For the diagnosis, intraductal endoscopic ultrasound is the most sensitive (64%) and specific (95%) test. However, the majority of cases require a combination of several different diagnostic tests, as there is no single investigation that can rule out malignancy in this group of patients. For the treatment, serial endoscopic or percutaneous dilatations provide 1- and 3-year biliary duct patency in 80 and 60% of patients, respectively. Dilatation and stenting are the most common interventions, although the optimal duration of treatment has still not been clearly defined. Bile duct resection and/or bilioenteric bypass are currently indicated only for patients with preserved liver function. For all other patients, benign DS can be treated with endoscopic dilatation with short-term stenting. This approach is effective and safe and does not increase the risk of malignant transformation or complications for liver transplant candidates. During the last decade, the use of self-expandable metallic stents for benign diseases has become an innovative option. The aim of this article is to review the diagnostic and therapeutic strategies for patients affected by PSC and DS with specific emphasis on the outcomes of patients treated with temporary stents.

Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA)

“…Radiologically, pCCA usually appears as a bile duct stricture 207 . In this instance, MRI plus magnetic resonance cholangiopancreatography represents the imaging procedure with the highest diagnostic accuracy for localizing and sizing the stricture; thus, the challenge is the definitive demonstration of malignancy [208][209][210][211] .…”

“…Even more challenging is the diagnosis of CCA in patients with PSC. Biliary strictures, occurring at the time of PSC presentation in 15-20% of patients, might be of malignant nature in 10-15% of the cases 207 . MRI, CT, endoscopic ultrasonography or 18 FDG PET-CT cannot definitively demonstrate the neoplastic nature of the stricture [208][209][210][211]217 .…”

A Rare Case of 18-year-old female with Primary Sclerosing Cholangitis, Mixed Connective Tissue Disease, Short Stature

“…Biliary stenting was performed in this patient to help the stream of the bile. (9) Even though studies show that UDCA therapy improve biochemical parameters but the overall beneficial effects for patients with PSC, in particular, survival benefit, are still uncertain. Immunosuppression in PSC is controversial and the majority of centers and publications do not recommend a routine administration of corticosteroids and other immunosuppressants.…”

Asia-Pacific consensus guidelines for endoscopic management of benign biliary strictures

“…Endoscopic intervention can relieve the obstruction and preserve liver function. 112,113 Limited data suggest that repeat endoscopic therapy could achieve longer survival time than predicted survival time in patients with PSC and dominant strictures. 114 Gotthardt et al 39 prospectively evaluated the outcome of long-term endoscopic treatment in patients with PSC.…”