Researchers from Heidelberg, Germany, evaluated the development of dominant bile duct stenoses in patients with primary sclerosing cholangitis treated with ursodeoxycholic acid.
A total of 106 patients, treated for up to 13 years with ursodeoxycholic acid, were enrolled in the prospective study.
The development of major bile duct stenoses and the efficacy of endoscopic measures were evaluated.
Of the patients, 10 had major duct stenoses at entry. During a median follow-up period of 5 years, another 43 developed a dominant stenosis.
Some 52 patients with dominant stenoses were treated endoscopically by repeated balloon dilatations and 5 patients were temporarily stented.
|5-year survival rates after endoscopic dilation:|
Stage 2 disease: 100%
Stage 3: 72%
Stage 4: 50%
| Journal of Hepatology |
Complications of endoscopic procedures were pancreatitis (5.2%), bacterial cholangitis (3.3%), and bile duct perforation (0.5%).
Five years after the first dilatation of a dominant stenosis, the Kaplan-Meier survival rates free of liver transplantation were 100% in stage 2, 72% in stage 3, and 50% in stage 4 disease.
The researchers found that the actuarial survival free of liver transplantation of the whole group at 3, 5, and 7 years were 0.987, 0.935, and 0.891. The corresponding survival rates, predicted with the Mayo multicenter survival model, were 0.860, 0.775, and 0.737.
Investigator Adolf Stiehl, of the University of Heidelberg, said on behalf of fellow authors, "In advanced disease, occlusion of major bile ducts with time occurs in the majority of patients."
"Endoscopic opening of dominant stenoses is effective and appears to be a valuable addition to the medical treatment of such patients," it was concluded.