stents/tubes and ballon dilitation

[Guest guest]

Does anyone know why sometimes stents and or tubes are used and other

times balloon dilitation is used? Is the purpose of both procedures to keep

the primary bile duct open?

--Adam (been ballooned twice, never stented)

> > Hi, my name is Carol. I had a liver tx in April 1996 due to PSC. I

> > was doing great; the last 2 months my numbers started elevating; I

> > just had a liver biopsy and was told the disease is recurring.

[Guest guest]

Stents are used after balloon dilation to

keep the duct from re-closing. I have read, however that some patients ducts

will stay open after several dilation and stent procedures so that they no

longer need the stents.

From: curveball3281

Sent: Monday, December 22, 2003

8:42 PM

To:

Subject:

stents/tubes and ballon dilitation

Does anyone know why sometimes stents and or tubes are used and other

times balloon dilitation is used? Is the

purpose of both procedures to keep

the primary bile duct open?

--Adam (been ballooned twice, never

stented)

> > Hi, my name is Carol. I had a liver tx in

April 1996 due to PSC. I

> > was doing great; the last 2 months my

numbers started elevating; I

> > just had a liver biopsy and was told the

disease is recurring.

[Guest guest]

Hi Adam;

The only paper I have found that compares the beneficial effects and

risks of stenting versus balloon dilation in PSC patients is this one

(see below), and it seems to indicate that stenting does not offer

significant advantages over dilation alone.

Am. J. Gastroenterol. 96: 1059-1066 (2001)

Balloon dilation compared to stenting of dominant strictures in

primary sclerosing cholangitis.

Kaya M, sen BT, Angulo P, Baron TH, s JC, Gostout CJ,

Lindor KD

Division of Gastroenterology and Hepatology, Mayo Clinic and

Foundation, Rochester, Minnesota 55905, USA.

OBJECTIVE: In some patients with primary sclerosing cholangitis

(PSC), a localized, high-grade (dominant) stricture may be the

principal cause of symptoms and hyperbilirubinemia. The aim of this

retrospective study was to compare the beneficial effects and risk of

balloon dilation alone versus dilation followed by stenting in PSC

patients with dominant strictures. METHODS: Charts from a group of

1009 patients with PSC seen over 10 yr were reviewed to identify

those patients who had undergone endoscopic or percutaneous

therapeutic intervention. Procedural and clinical data were recorded.

RESULTS: A total of 71 PSC patients, median age of 49 yr (range 18-78

yr) were identified. Thirty-four patients were treated with

endoscopic balloon dilation alone, and 37 patients were treated with

balloon dilation plus stent placement. Stents were placed

percutaneously (n = 19), endoscopically (n = 14), or using both

interventions (n = 4). Both groups were comparable at baseline with

regards to age, symptoms, and bilirubin level. The median duration of

follow-up after intervention was similar in both groups. The number

of intervention-related complications (30 vs 6, p = 0.001) as well as

the incidence of acute cholangitis (p = 0.004) were more common in

the stent group compared to the balloon dilation group. There were

more complications related to percutaneous stent placement than

endoscopic placement (23 vs 7. p = 0.001). There was no significant

difference between the two groups with regards to improving

cholestasis. CONCLUSIONS: There was no additional obvious benefit

from stenting after balloon dilation in the treatment of dominant

strictures in PSC patients. Stenting was associated with more

complications, and its role after dilation should be assessed in a

randomized trial rather than being accepted as routinely indicated in

this setting.

PMID: 11316147

Best regards,

Dave (father of (18 yr); dx PSC 07/03; dx UC 08/03)

> Does anyone know why sometimes stents and or tubes are used and

other

> times balloon dilitation is used? Is the purpose of both

procedures to keep

> the primary bile duct open?

>

> --Adam (been ballooned twice, never stented)

[Guest guest]

In general my understanding is that baloon dilation would be used

either for less severe strictures or to open the ducts up enough for

a stent to be inserted. More severe strictures would require a stent

to be inserted to hold it open for a longer term. Balloon dilation

can also be used in smaller ducts that are not stentable. The

advantage of balloon dilation only is that you do not need to have a

repeat ERCP in 3 months to have the stent changed or removed. So if

that has been sufficient enough to keep things working that is to

your advantage.

In my case I have a fairly large dominent stricture in the common

bile duct of about 8cm in length that has required stenting to

releive the blockage. Hope that clears it up a bit.

in Seattle

> Does anyone know why sometimes stents and or tubes are used and

other

> times balloon dilitation is used? Is the purpose of both

procedures to keep

> the primary bile duct open?

>

> --Adam (been ballooned twice, never stented)

>

>

[Guest guest]

Dave,

Thank you for this article. Since becoming active again, I have found your

posts very very helpful. I very much appreciate the abstracts and links that

you include in your posts.

I will try to confirm this with my doctors, but I think that some clinics don't

even

bother with stents anymore.

Adam

> > Does anyone know why sometimes stents and or tubes are used and

> other

> > times balloon dilitation is used? Is the purpose of both

> procedures to keep

> > the primary bile duct open?

> >

> > --Adam (been ballooned twice, never stented)