Structured Protocol for Benign Biliary Anastomotic Strictures: Impact on Long-Term Clinical Effectiveness

Area of Science:

• Gastroenterology
• Interventional Radiology
• Surgical Innovation

Background:

• Benign anastomotic biliary strictures can complicate surgical procedures.
• Percutaneous drainage is a key intervention for managing these strictures.
• Evaluating treatment protocols is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the long-term clinical effectiveness of percutaneous drainage for benign biliary strictures before and after implementing a structured protocol.
• To assess the impact of a structured protocol on the need for surgical revision and long-term patency rates.

Main Methods:

• A retrospective study of 305 adult patients undergoing percutaneous biliary drainage between 1994 and 2015.
• Comparison of outcomes between patients treated before (n=234) and after (n=71) protocol implementation.
• Analysis of surgical revision rates, patient characteristics, treatment variables, and Kaplan-Meier survival analysis for surgical avoidance and patency.

Main Results:

• Overall surgical avoidance was 72.8%, with higher rates after protocol implementation (81.7% vs 71.1%).
• Five-year surgical avoidance (80.8% vs 69.1%) and patency rates (76.8% vs 73.8%) improved with the protocol.
• Larger maximum drain size was significantly associated with a lower frequency of surgical revision (p = 0.0006).

Conclusions:

• Percutaneous drainage is effective for benign biliary anastomotic strictures, with or without a structured protocol.
• The structured protocol demonstrated a trend towards improved surgical avoidance and significantly increased time to surgical revision and patency rates.
• Optimizing drain size is an important factor in achieving better outcomes.