Short-term biliary dilatation and stenting in primary sclerosing cholangitis

Operative biliary dilatation and prolonged percutaneous transhepatic biliary stenting have been useful in the management of primary sclerosing cholangitis, both intrahepatic and extrahepatic biliary strictures regressing after 12-16 months of treatment. We report the results of less prolonged treatment in a further four patients, in whom removal of a percutaneous transhepatic biliary stent 3-11 months after treatment led to an improvement in radiological appearances of the extrahepatic bile ducts, with no discernible effect on intrahepatic disease. Extrahepatic stricture recurred rapidly in one patient stented for only 3 months. Operative biliary dilatation and stenting for 5-11 months may lead to regression of extrahepatic biliary strictures in patients with primary sclerosing cholangitis, whereas intrahepatic disease requires stenting for 12-16 months. Further study is required to determine the applicability of this approach to primary sclerosing cholangitis.