Management of bile duct strictures. An evolving strategy
J. M. Millis, R. K. Tompkins, M. J. Zinner, W. P. Longmire Jr and J. J. Roslyn
Department of Surgery, UCLA School of Medicine 90024.
In an effort to determine the role of interventional radiologic and
endoscopic techniques in the management of benign biliary strictures, a
retrospective analysis was carried out on 194 consecutive patients with
bile duct strictures treated at UCLA between 1955 and 1990. Patients were
classified as group 1 (1955 through 1979; n = 138) or group 2 (1980 through
1989; n = 56). Follow-up was for a minimum of 24 months and was in excess
of 3 years in 179 patients (92%). Although the incidence of recurrent
strictures was similar in the two groups (21% and 23%), the reoperation
rate was significantly lower (P less than .02) in group 2 (6%) than in
group 1 (21%). Percutaneous transhepatic biliary dilatation, used in 20
patients in group 2, was successful in 13 (93%) of 14 patients with
anastomotic strictures and three (50%) of six patients with primary
strictures (P less than .05). We conclude that surgical reconstruction
remains the standard therapy for patients with primary bile duct
strictures. Percutaneous transhepatic biliary dilatation has limited
usefulness for these patients, but may be more appropriate for those with
anastomotic strictures.
