Gallbladder and Biliary Intervention Biliary Manometry versus Clinical Trial: Value as Predictors of Success after Treatment of Biliary Tract Scott J. Savader, MD John L. Cameron, MD Henry A. Pitt, MD Anthony C. Venbrux, MD Scott 0 . Trerotola, MD2 Min-Chi Chen, MS Gunnar B. Lund, MD Sally E. Mitchell, MD Floyd A. Osterman, Jr, MD Index terms: Bile ducts, interventional procedure, 76.1228 Bile ducts, stenosis or obstruction, 76.289,76.3, 76.43,76.458 JVIR 1994; 5:757-763 Abbreviations: BMPT = biliary mano- metric-perfusion test, GEE = generalized estimating equations, PBC = percutaneous balloon cholangioplasty 'From the Division of Cardiovascular and Interventional Radiology, Department of Radiology, Blalock 545-CVDL (S.J.S., A.C.V., S.O.T., G.B.L., S.E.M.,F.A.O.); the Department of Surgery (J.L.C., H.A.P.); and the Department of Biostatistics (M.C.C.), Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. From the 1994 SCVIR annual meeting. Received January 11,1994; revision requested March 4; revision received May 16; ac- cepted June 1. Address reprint re- quests to S.J.S. Current address: Department of Radiol- ogy, Indiana University Medical Center, Indianapolis. O SCVIR, 1994 PURPOSE: To evaluate the biliary manometric-perfusion tes (BMPT) and clinical trial as predictors of long-term success percutaneous and surgical treatment of biliary tract strictur PATIENTS AND METHODS: After percutaneous intervention or SUP- gical repair of extrahepatic bile duct strictures, 43 patients went long-term biliary intubation (mean, 13 months) with 61 nal-external stents. Before removal of the stents, all 43 patie derwent a BMPT (n = 65) and 24 underwent a 23-week clinical tri (n = 27) with stents positioned above the treated region. Pati were followed up 1-46 months (mean, 16 months) after sten moval, with clinical outcome determined by means of physic amination, biochemical evaluation, chart review, and teleph terview. RESULTS: With logistic regression analysis, the BMPT and c trial were shown to have equal predictive value in determin treatment success or failure. Eighty-four percent of the clini comes were correctly predicted with BMPT, versus 88% for the clini- cal trial. Kaplan-Meier survival curve analysis demonstrated probability of remaining stricture free at 1 year after passing a BMPT and after passing a clinical trial to be 90% and 86% (P = .55), respectively. CONCLUSION: BMPT and clinical trial have similar capabili the prediction of long-term patency after treatment of benig iary tract strictures, but the BMPT is less costly and time co ing for the patient. B I L I A R Y strictures are a difficult and challenging problem for both the interventionalist and surgeon owing to the relatively high rate of recur- rence after treatment. Surgical re- pair of biliary strictures has a suc- cess rate of 79%-88% (1,2). Percuta- neous balloon cholangioplasty (PBC) has a success rate of 55%-85% (24). Optimum results are best achieved early in the course of therapy, as fa- vorable outcomes decrease second- ary to the scarring and fibrosis that occur with more attempts at repair (5). Because of the grave consequences of an incomplete or failed repair, a method for evaluating the results of the initial therapy is desirable. Pitt eta1 (2,5) and Cameron et a1 (6) have demonstrated that long-term intubation with large-caliber silicone stents can improve patency rates. Beinart et a1 (7) and vansonnenberg et a1 (8) have described provocative biliary-manometric perfusion tests (BMPTs) for evaluation of biliary flow dynamics. However, to date, a paucity of objective data is available to determine when percutaneous bil- iary intubation can be discontinued, and no test that allows prediction of long-term success has been de- scribed, to our knowledge. We have