Ksissa O, Dioscoridi L, Forti E, Pugliese F, Cintolo M, Palermo A, Mutignani M. Does wire-guided cystotome dilation for difficult benign bilio-pancreatic strictures guarantee long-term patency? A narrative mini-review of the literature. World J Gastrointest Endosc 2025; 17(9): 106936 [DOI: 10.4253/wjge.v17.i9.106936]
Corresponding Author of This Article
Lorenzo Dioscoridi, MD, PhD, Digestive and Interventional Endoscopy Unit, ASST Niguarda, Piazza dell’Ospedale Maggiore 3, Milan 20162, Italy. lorenzo.dioscoridi@ospedaleniguarda.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2025; 17(9): 106936 Published online Sep 16, 2025. doi: 10.4253/wjge.v17.i9.106936
Does wire-guided cystotome dilation for difficult benign bilio-pancreatic strictures guarantee long-term patency? A narrative mini-review of the literature
Omar Ksissa, Lorenzo Dioscoridi, Edoardo Forti, Francesco Pugliese, Marcello Cintolo, Andrea Palermo, Massimiliano Mutignani
Omar Ksissa, Department of Gastroenterology, Irccs Multimedica, Sesto San Giovanni (MI), Milan 20099, Italy
Lorenzo Dioscoridi, Edoardo Forti, Francesco Pugliese, Marcello Cintolo, Andrea Palermo, Massimiliano Mutignani, Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan 20162, Italy
Co-first authors: Omar Ksissa and Lorenzo Dioscoridi.
Author contributions: Ksissa O collected the data and wrote the core of the paper; Dioscoridi L performed the analysis of data and cowrote the manuscript; Ksissa O and Dioscoridi L contributed equally to this article, and they are regarded as the co-first authors of this manuscript; Forti E and Pugliese F performed the literature research for background and the table; Cintolo M prepared the table; Palermo A and Mutignani M performed the follow-up of patients involved; Mutignani M revised the final version of the paper; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lorenzo Dioscoridi, MD, PhD, Digestive and Interventional Endoscopy Unit, ASST Niguarda, Piazza dell’Ospedale Maggiore 3, Milan 20162, Italy. lorenzo.dioscoridi@ospedaleniguarda.it
Received: March 11, 2025 Revised: May 22, 2025 Accepted: August 25, 2025 Published online: September 16, 2025 Processing time: 185 Days and 13.2 Hours
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.
Core Tip: Cystotome use for the dilation of difficult strictures has been reported as both technically feasible and clinically effective. Nonetheless, the literature remains limited, likely due to the technical complexity of the procedure and the specialized expertise that it requires. The present mini-review underlines the need of long-term outcomes after cystotomy dilation of difficult biblio-pancreatic strictures. Technical feasibility was determined but recurrence rate and long-term latency are still almost not reported.
