Does wire-guided cystotome dilation for difficult benign bilio-pancreatic strictures guarantee long-term patency? A narrative mini-review of the literature.

Abstract

Background: Difficult benign biliary and pancreatic strictures are generally managed by using a Soehendra screw or cystotome. Many previous studies described the techniques without information even of mid-term follow-up.

Aim: To confirm the long-term patency of dilated strictures following the application of a cystotome.

Methods: Data were collected from analysis of the literature using appropriate key words. Technical success was defined as the ability to traverse the stricture. Clinical success was defined as drainage of biliary or pancreatic strictures and symptoms' resolution. PRISMA criteria were followed to write the present review.

Results: Three papers were selected following the inclusion criteria. Our case series was added to the review of the literature. Reported technical and clinical success rates were 100% in all the studies and the rate of adverse events was reported from 9.1% to 60%. However, data on follow-up and long-term patency are scant.

Conclusion: The use of a cystotome can be considered an alternative method for dilation of difficult pancreatic and biliary strictures, after the failure of conventional modalities. According to available literature, long-term results are rarely described, and this is still a crucial issue to evaluate the effectiveness of the technique.