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Bret T. Petersen, MD, FASGE

Associate Editor
Pancreatobiliary

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Biography

Bret T. Petersen, MD, FASGE is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.

Disclosures

Consultant 

Boston Scientific 

Advisory Board 

Ethicon/J & J

 

Summaries

Plastic Still Works for Post-cholecystectomy Biliary Strictures but Takes Time

Bret T. Petersen, MD, FASGE reviewing Costamagna G, et al. Gastrointest Endosc 2019 June 5.

The authors of this study previously demonstrated the utility of therapy employing multiple plastic stents for a mixed variety of benign biliary strictures. In this study, they sought to evaluate this approach for post-cholecystectomy biliary strictures (PCBSs) without complete transection. One hundred fifty-four patients (56.5% females; mean age 53 years) underwent serial ERCPs with stent exchange and increase in number of stents every 3 to 4 months until resolution; 43% of PCBSs involved or were in close proximity to the hepatic confluence. Strictures resolved in 96.7% after a mean treatment period of 11.8 (+/- 6.4) months using a mean maximum number of 4.3 (+/-1.6) side-by-side plastic stents. Pain, jaundice, or cholangitis required unanticipated exchange in 7.4% of patients. Follow-up was available in 85.2% of patients after a mean of 11.1 (+/- 4.9) years. PCBSs recurred in 12 patients (9.4%), but retreatment yielded long-term resolution in 10/12 cases. Overall, 2 patients underwent hepaticojejunostomy. There was no mortality.

Comment:
Dr. Costamagna and colleagues initially taught us the benefit of maximizing stent number and caliber for the treatment of benign biliary strictures. In this study, they confirm the utility of this approach in a specific subset of patients, with impressive long-term results. The intensity (stent number) and duration of therapy are longer than many physicians and families have patience for. Similar results with use of covered metal stents for strictures adequately removed from the confluence should reduce costs by simplifying, and perhaps shortening, the therapeutic regimen.
Note to readers:
At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Bret T. Petersen, MD, FASGE
Bio and Disclosures

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Citation(s):
Costamagna G, Tringali A, Perri V, et al.  Endotherapy of postcholecystectomy biliary strictures with multiple plastic stents: long-term results in a large cohort of patients. Gastrointest Endosc 2019 June 5. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.05.042)