BACKGROUND AND AIMS Endoscopic therapy of benign biliary strictures with multiple plastic stent (MPS) placement has shown satisfactory results. However, the literature describes various benign biliary stricture etiologies. The aim of this study was to evaluate long-term MPS results in patients with postcholecystectomy biliary strictures (PCBSs). METHODS PCBS patients without complete bile duct transection were included. ERCP consisted of placing an increasing plastic stent number over time, exchanged at regular intervals (3-4 months), until complete morphologic stricture disappearance. After stent removal, patient follow-up comprised liver function tests and clinical assessment. RESULTS One hundred fifty-four patients (43.5% men; mean age, 53 years) were enrolled; in 43% of the cases, PCBSs were involved or were close to the main hepatic confluence. PCBS resolution rate was 96.7% (n = 149). A mean maximum number of 4.3 ± 1.6 stents were placed side-by-side; a mean of 4.2 ± 1.5 ERCPs per patient was needed to obtain PCBS resolution during a mean treatment period of 11.8 ± 6.4 months. Unscheduled stent exchange because of cholangitis, jaundice, or pain occurred in 7.4% of cases. Procedure-related mortality was absent. Follow-up data were available in 85.2% of cases. After a mean follow-up of 11.1 ± 4.9 years, stricture recurrence rate was 9.4% (n = 12). Subsequent to retreatment, 83.3% of patients (n = 10) were asymptomatic after a mean time of 9 years, whereas 2 patients underwent hepaticojejunostomy because of failed retreatment. Statistical analysis revealed no risk factors for PCBS recurrence after MPS. CONCLUSIONS Endoscopic therapy of PCBSs with MPSs is safe and effective at long-term follow-up. PCBSs involving or close to the main hepatic confluence were successfully treated with MPSs. PCBS recurrence rate is low and can be successful endoscopically retreated without precluding possible surgical treatment.

中文翻译：

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胆囊切除术后胆管狭窄的内镜治疗采用多个塑料支架：长期的结果在大量患者中得到了应用。

背景与目的内镜下多塑料支架置入术治疗良性胆管狭窄已显示出令人满意的效果。然而，文献描述了各种良性胆道狭窄病因。这项研究的目的是评估胆囊切除术后胆道狭窄（PCBSs）患者的长期MPS结果。方法纳入没有完全胆管横切的PCBS患者。ERCP包括随着时间的推移放置数量不断增加的塑料支架，并定期（3-4个月）进行更换，直到形态学完全消失。取出支架后，对患者进行随访，包括肝功能检查和临床评估。结果纳入154例患者（男性43.5％;平均年龄53岁）; 在43％的情况下，多氯联苯参与或接近主要肝脏汇合处。PCBS分辨率为96.7％（n = 149）。并排放置平均最大数量为4.3±1.6的支架；在平均11.8±6.4个月的治疗期内，每位患者平均需要4.2±1.5 ERCPs才能获得PCBS分辨率。7.4％的病例由于胆管炎，黄疸或疼痛而进行了计划外的支架更换。缺乏与手术相关的死亡率。在85.2％的病例中可获得随访数据。平均随访11.1±4.9年后，狭窄复发率为9.4％（n = 12）。再治疗后，平均9年后83.3％的患者（n = 10）无症状，而2名患者因再治疗失败而进行了肝空肠造口术。统计分析显示，MPS后没有PCBS复发的危险因素。结论内镜治疗多发性硬化症的PCBSs在长期随访中是安全有效的。用MPS成功治疗了涉及或接近主要肝融合的PCBS。PCBS复发率低，可以在内镜下成功治愈，而无需排除可能的手术治疗。