Percutaneous transhepatic cholangioscopy-assisted procedures for the management of postoperative benign bilioenteric anastomotic strictures with or without biliary stones

Abstract

BACKGROUND

Postoperative benign bilioenteric anastomotic stricture (BBAS) is a serious complication of biliary surgeries.

AIM

To determine the efficacy and safety of percutaneous transhepatic cholangioscopy (PTCS)-assisted procedures, including stricture dilation and recanalization for BBAS and biliary stone therapy for concomitant stones.

METHODS

Patients with BBAS who received PTCS-assisted procedures were included. Primary outcomes were anastomotic patency (including initial anastomotic patency after stricture dilation and cumulative anastomotic patency after PTCS catheter removal) and treatment success (i.e., negative clinical clamping trial and removable indwelling PTCS catheter). Secondary outcomes were technical success for the three PTCS-assisted procedures, duration of the indwelling PTCS catheter, and adverse events.

RESULTS

Forty patients were included; 32 underwent PTCS-assisted stricture dilation/recanalization and 36 underwent biliary stone therapy. The initial patency rates were 58.1% and 41.9% at 1 and 2 years, respectively, and the cumulative patency rates were 74.3%, 59.7, 49.8%, and 34.8% at 1, 3, 5, and 7 years, respectively. The treatment success rate was 90.6% (29/32) for PTCS-assisted stricture procedures. The technical success rates were 100% (31/31), 87.5% (7/8), and 94.5% (34/36) for PTCS-assisted stricture dilation, recanalization, and biliary stone therapy, respectively. The median duration of the indwelling PTCS catheter in the 29 patients with treatment success was 6 (range: 2-109) months. Only one patient experienced acute bleeding, which was manageable.

CONCLUSION

PTCS-assisted procedures are efficacious and safe for the management of BBAS and concomitant biliary stones. Placement of an indwelling PTCS catheter across the anastomosis after stricture dilation improves the anastomotic patency.

Keywords: Benign bilioenteric anastomotic stricture; Percutaneous transhepatic cholangioscopy; Anastomotic patency; Stricture dilation; Anastomotic recanalization; Biliary stone; Indwelling percutaneous transhepatic cholangioscopy catheter

Core Tip: Forty patients with benign bilioenteric anastomotic stricture received percutaneous transhepatic cholangioscopy (PTCS)-assisted procedures, including stricture dilation/recanalization and stone therapy. The cumulative anastomotic patency due to a PTCS catheter across the anastomosis placed 6 months ago is superior to initial anastomotic patency (balloon dilation alone), i.e., 74.3% and 69.7% vs 58.1% and 41.9% at 1 and 2 years, respectively, with a treatment success rate of 90.6% (29/32). Technical success for stone therapy, including 20 patients with electrohydraulic or laser lithotripsy, was achieved in 34 (94.4%) patients. PTCS-assisted procedures are efficacious, especially for the treatment of intrahepatic stones. PTCS catheter placement across the anastomosis after stricture dilation can improve the anastomotic patency.