Primer Sklerozan Kolanjitte Dominant Darlıkların Endoskopik Yönetimi: 12 Yıllık Tek Merkez ve Tek Endoskopist Deneyimi

Öz

Giriş ve Amaç: Primer sklerozan kolanjitte görülen dominant biliyer darlıklar, klinik açıdan önemli bir komplikasyon olup sıklıkla endoskopik tedavi gerektirmektedir. Önerilen endoskopik yaklaşım, balon dilatasyonu ile kısa süreli stentleme kombinasyonu veya tek başına balon dilatasyonu şeklindedir. Ancak, bu alandaki uzun dönem gerçek yaşam verileri sınırlıdır. Gereç ve Yöntem: 2011–2023 yılları arasında üçüncü basamak bir merkezde dominant darlık nedeniyle endoskopik retrograd kolanjiyopankreatografi uygulanan ardışık primer sklerozan kolanjit hastaları retrospektif olarak değerlendirildi. Tüm girişimler deneyimli tek bir endoskopist tarafından gerçekleştirildi. Uygulamalar, endoskopik balon veya buji dilatasyonunu takiben kısa süreli biliyer drenajı içermekteydi. Çalışmanın primer sonlanım noktası, 24. ayda nüksüz sağkalım olarak belirlendi. Sekonder sonlanım noktaları ise klinik ve biyokimyasal yanıt, hastalık progresyonu ve güvenlik sonuçlarıydı. Bulgular: Toplam 35 hasta (ortalama yaş: 42.0 ± 13.5 yıl; %68.6 erkek) üzerinde 138 endoskopik girişim gerçekleştirildi; hasta başına medyan üç işlem yapıldı. Olguların %94.3’ünde dilatasyon uygulandı ve tüm hastalara kısa süreli stent veya nazobiliyer drenaj sağlandı (medyan süre: 15 gün). Üçüncü ayda hastaların %78.8’i asemptomatikti ve %80.0’inde alkalen fosfataz düzeyinde ≥ %20 azalma saptandı. Yirmi dördüncü ayda nüksüz sağkalım oranı %45.4 olarak bulundu. Genel komplikasyon oranı %8.0 olup en sık görülenler kolanjit, pankreatit ve stent migrasyonuydu. İşlem ilişkili mortalite izlenmedi. Sonuç: Endoskopik tedavi, özellikle kısa süreli drenaj ile birlikte uygulanan balon dilatasyonu, primer sklerozan kolanjitte dominant darlıkların yönetiminde güvenli ve etkili bir yöntem olarak görünmektedir. Bu yaklaşım kısa dönemde anlamlı klinik ve biyokimyasal düzelme sağlamakta ve kabul edilebilir bir güvenlik profili sunmaktadır. Bununla birlikte, yüksek nüks oranı hastalığın kronik ve tekrarlayıcı doğasına işaret etmekte olup uzun dönemli yapılandırılmış izlemin önemini vurgulamaktadır.

Anahtar Kelimeler

• Primer Sklerozan Kolanjit
• Safra Yolu Darlıkları
• Endoskopik retrograd kolanjiyopankreatografi
• Balon Dilatasyonu
• Biliyer Drenaj

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

Öz

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.

Anahtar Kelimeler

• Sclerosing Cholangitis
• Bile Duct Strictures
• Endoscopic retrograde cholangiopancreatography
• Balloon Dilation
• Biliary Drainage

Kaynakça

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