Endoscopic stent therapy for dominant extrahepatic bile duct strictures in primary sclerosing cholangitis

Background: In 15% to 20% of patients with primary sclerosing cholangitis, a dominant stricture of the extrahepatic bile ducts may be responsible for declining results of serum biochemical liver tests and may contribute to symptoms such as jaundice, cholangitis, pruritus, and right upper quadrant pain. Methods: Retrospectively, over the period 1985 to 1994, we evaluated 25 patients who had been treated by endoscopic stent therapy after declining results of serum biochemical liver tests and symptoms attributable to dominant extrahepatic bile duct strictures. Serum biochemical liver test results and symptoms were compared before and after treatment. Results: Endoscopic therapy was technically successful in 21 patients (84%). In these 21 patients results of all serum biochemical liver tests improved significantly (p < 0.001) within 6 months of stent therapy. During median follow-up of 29 (2 to 120) months after stent removal, 12 patients (57%) remained asymptomatic with stable serum biochemical liver tests and 4 (19%) had clinical and biochemical relapse of disease that responded favourably to additional endoscopic therapy. Early procedure-related complications occurred in 14% of therapeutic endoscopic biliary procedures. Conclusions: Endoscopic stent therapy is a safe and effective treatment modality for an acute exacerbation of disease caused by dominant extrahepatic bile duct strictures in patients with primary sclerosing cholangitis.