Influence Factors Analysis For Recurrence Of Benign Biliary Stricture After ERCP Treatment

Objective: In recent years,the incidence of benign biliary stricture has been on the rise with the increasing of biliary diseases.Iatrogenic bile duct injury treated with cholecystectomy,common bile duct incision and T tube drainage or orthotopic liver transplantation is a major cause of benign biliary stricture.With the progress of endoscopic surgical techniques and the development of the clinical instruments,endoscopic biliary stent implantation has become the first choice for benign biliary stricture treatment,especially in patients accepted orthotopic liver transplantation(OLT).But,recurrent rates is higher in benign biliary stricture patients treated with endoscopic biliary stent implantation.Repeated treatment is a burden to the patient's mentality and physiology.As the specialty of patients accepted OLT,the effectiveness and safety of biliary stricture after OLT via Endoscopic Retrograde Cholangiopancreatography(ERCP)is still controversy.We retrospectively analyzed the patients' clinical data who accept endoscopic biliary stent implantation for benign biliary stricture in ERCP diagnosis and treatment technology training center,the first hospital of Lanzhou University.The influence factors of recurrence in benign biliary stricture after ERCP treatment.The safety and efficiency of OLT patients who underwent ERCP was analyzed.Methods: 783 patients who accept treatment by endoscopic biliary stent implantation for benign biliary stricture were recruited in ERCP diagnosis and treatment technology training center since Jan.2011 to Dec.2015.According to the exclusion criteria,the following cases were excluded: 34 cases who had been treated via percutaneous transhepatic cholangial drainage,129 patients with biliary tract malignant tumors,10 cases combining malignant tumors of other systems,4 patients with biliary stricture caused by compression,131 cases treated with ERCP before,19 cases of patients merger with end-stage liver disease,29 cases combining with intrahepatic bile duct stones,13 cases with other reasons,18 cases with lost of follow-up.396 cases of eligible patients were selected,who were totally accepted 863 times ERCP treatment.First of all,according to recurrence or not after endoscopic biliary stent was pull out in 12 months,52 cases were defined in recurrence group,344 cases were defined in no recurrence.Analyzethe risk factors caused recurrence: general information of patients(gender,age,BMI,hypertension,diabetes,chronic hepatitis,nonalcoholic fatty liver disease,chronic pancreatitis,recurrent cholangitis),previous history of biliary tract surgery(cholecystectomy,common bile duct incision+ T tube drainage,orthotopic liver transplantation),preoperative symptoms of ERCP(abdominal pain,fever,jaundice,nausea and vomiting),Imaging examination results(expansion degree of narrow proximal,calculi,nipple diverticulum,stricture length,stricture area and number),ERCP operation and biliary stent(operation time,EST incision length,number of stent placement,the types of stents,stents diameter,length and time of stent placement).Then,all patients were regrouped,in which 20 cases defined in OLT group,376 cases were defined no OLT group.Preoperative baseline conditions,improved liver function after operation,intraoperative complications and postoperative complications and treatment effect was compared in the two groups.SPSS 22.0 software was used for statistical analyzed.Results: We explored the influence factors for recurrence of benign biliary stricture after ERCP treatment.The data showed that hepatic portal biliary stricture(OR=4.992,95%CI=1.106-22.532),stricture length(OR=4.686,95%CI=1.866-11.764),common bile duct incision and T tube drainage(OR=4.433,95%CI=1.205-16.306)and expansion degree of narrow proximal(OR=2.052,95%CI=1.585-2.655)was the independent risk factors of stricture recurrence.Time(OR=0.922,95% CI=0.893-0.952)and the number(OR=0.254,95% CI=0.090-0.717)of stent placement was the protection factors for recurrence of benign biliary stricture.The safety and efficiency of OLT patients who underwent ERCP was analyzed.Intraoperative complications was compared in the two groups.The data showed that hypoxemia,bradycardia,tachycardia,lower blood pressure,there was no statistically significant difference.The values of P was greater than 0.05.Postoperative complications were compared in the two groups.The data showed that PEP,hemorrhage,cholangitis and perforation,the differences were not statistically significant.Postoperative laboratory results in AST,ALT,GGT,ALP,TBIL and DBIL were significantly lower than the preoperative in OLT group,the differences were statistically significant.The values of P was less than 0.001.Postoperative laboratory results in WBC and NET% were no statistically significant difference in preoperative.Postoperative laboratory results in AST,ALT,GGT,ALP,TBIL and DBIL were significantly lower than the preoperative in no OLT group,the difference was statistically significant.The values of P was less than 0.001.Postoperative laboratory result in WBC was no statistically significant difference in preoperative.The values of P was greater than 0.05.The rate of recurrence of stricture was obviously higher in OLT group than no OLT group,the difference was statistically significant.the difference was statistically significant(P=0.009).Conclusion: Recurrence of benign biliary stricture after endoscopic biliary stent is the result of many factors interaction.hepatic portal biliary stricture,stricture length,common bile duct incision and T tube drainage and expansion degree of narrow proximal are independent risk factors for recurrence of benign biliary stricture.Time and number of stent placement are the protection factors for recurrence of benign biliary stricture.It's safe and effective that benign biliary stricture of OLT patients is treated via ERCP.