The Clinical Study Of ERBD Versus Balloon Dilation In Patients With Benign Biliary Stricture And Risk Factors For Biliary Stent Migration

OBJECTIVEThe aim of this study was to evaluate technical, clinical efficacy, complications of plastic stents placement v.s. balloon dilation in patients with benign biliary stricture(BBS). And to elicite the risk factors for stent migration in patients with benign biliary strictures.METHODSThe first section:A total of 336 patients with benign biliary strictures were included in this study. They were assigned to ERBD (n=248) or balloon dilation(n=88). We observed the change of technical success rate and hepatic-function of the patients. Additional outcome parameters were assisted clinical success and treatment failure, as well as procedure-related complications.The second section:Data of 244 cases of endoscopic retrograde biliary drainage (ERBD) in treatment of benign biliary strictures from January 2005 to December 2009 were reviewed. Details noted included the cause and location of stricture, length and number of stents, direction of stent migration, manifestations of patients with migrated stent, and the methods used for retrieval of migrated stents.RESULTSThe technical success rate in the stent group and the balloon group were 98.4% and 97.7%respectively. Four hundred and eight biliary plastic stent placement procedures were performed for benign biliary strictures in 244 patients. Three hundred and five dilation procedures were performed in 86 patients. Complications were observed in 17.2% in the stent group and 15.1% in the dilation group (p<0.05). The hepatic-functions of stents group and ballon group were all improved after operative (p<0.05).There were 56 migrated stents in stents group. Compared to other factors, post-biliary-duct-exploration has statistical significantly lower migration rate (6.8% v.s.31.6%, p<0.05). Statistical differences were found in migration directions associated with location of stricture lession (23.1% v.s.76.9%, p<0.001; 73.3% v.s.26.7%, p<0.05). The length of stent is associated with migration direction (23.1%v.s.73.3%, p<0.05; 76.9% v.s.26.7%, p<0.05). Short stent tends to migrate proximately, whilst long stent more often migrates distally. Both single and double stents placement has higher migration rates than multiple stents placement (19.3%v.s.2.7%, p<0.05; 20.9%v.s.2.7%, p<0.05). However, this did not reach statistical significancy. Number of stents was not associated with migration diretion.CONCLUSIONIn patients with benign biliary strictures, stent placement and endoscopic balloon dilation alone were minimal invasive,safe,effective. The risk factors for plastic stent migration in treatment of benign biliary duct stricture were:etiology of stricure, location of lesion, length and number of stents. Therefore, stent migration rate can be significantly reduced if conditions being careful assessed in clinical practice.