Surgery or endoscopy for treatment of postcholecystectomy bile duct strictures?

Background: Surgery is considered the treatment of choice for postoperative biliary strictures. Recently, endoscopic stent placement has been proposed as an alternative to surgical management in selected patients. Methods: In this retrospective study, 157 patients with postoperative biliary strictures were included. Eighty patients (group A) were treated endoscopically and 77 by surgery (group B). Baseline characteristics of patients were comparable in both groups. Endoscopic therapy consisted of placement of endoprostheses, with trimonthly elective exchange for a 1-year period. Surgical therapy consisted of constructing a biliary-digestive anastomosis in normal ductal tissue. Data were evaluated according to intention-to treat analysis. Results: Successful treatment was achieved in 54% of group A and 73% of group B (P <0.001). Overall 31% of patients developed complications in group A and 23% of patients in group B (P <0.05). However, the rates of severe complications were comparable in both groups (11% versus 13%; P = not significant) In group A the mortality rate was 0% compared with 8% of group B (P <0.05). Recurrent stenosis was evidenced in 6% of patients of group A and 5% of patients of group B. Conclusions: Surgery provides a better long-term outcome over the endoscopy, because of patients with total obstruction are not amenable to endoscopic approach. When successfully done, endoscopic results are similar to surgical results with less mortality. (C) 2003 Excerpta Medica, Inc. All rights reserved.