Endoscopic Management of Dominant Strictures in Primary Sclerosing Cholangitis: Real-World Outcomes from a 12-Year Single-Endoscopist Experience

Authors : Kerem Kenarlı, Bülent Ödemiş, Nazmi Gökhan Ünver, Emir Tuğrul Keskin, Alper Macif, Kübra Köken, Göktürk Karataş, Ahmet Burak Fedai, Erdoğan Deniz

Pages : 130-138

Doi:10.17941/agd.1779521

View : 22 | Download : 19

Publication Date : 2026-02-20

Article Type : Research Paper

Abstract :Background and Aims: Dominant biliary strictures are a clinically important complication in primary sclerosing cholangitis that often require endoscopic therapy. Although balloon dilation with or without short-term stenting is recommended, long-term real-world outcome data remain limited. Materials and Methods: We retrospectively evaluated consecutive primary sclerosing cholangitis patients who underwent endoscopic retrograde cholangiopancreatography for dominant strictures between 2011 and 2023 at a tertiary referral center. All procedures were performed by a single experienced endoscopist. Interventions included endoscopic balloon or bougie dilation with subsequent short-term biliary drainage. The primary endpoint was recurrence-free survival at 24 months; secondary endpoints included clinical and biochemical response, disease progression, and safety outcomes. Results: Total of 35 patients (mean age 42.0 ± 13.5 years; 68.6% male) underwent 138 endoscopic procedures, with a median of three interventions per patient. Dilation was performed in 94.3% of cases, and all patients received short-term stenting or nasobiliary drainage (median duration 15 days). At three months, 78.8% of patients were asymptomatic and 80.0% achieved a ≥ 20% reduction in alkaline phosphatase. The 24-month recurrence-free survival rate was 45.4%. The overall complication rate was 8.0% (including cholangitis, pancreatitis, and stent migration), with no procedure-related mortality. Conclusion: Endoscopic management -particularly balloon dilation with short-term drainage- appears to be a safe and effective strategy for dominant strictures in primary sclerosing cholangitis, offering substantial short-term clinical and biochemical improvement with an acceptable safety profile. Nevertheless, the high recurrence rate highlights the chronic relapsing nature of the disease and emphasizes the need for structured long-term surveillance.
Keywords : Primer Sklerozan Kolanjit, Safra Yolu Darlıkları, Endoskopik retrograd kolanjiyopankreatografi, Balon Dilatasyonu, Biliyer Drenaj

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