Skip to main content

Advertisement

SpringerLink
Log in

Benign anastomotic biliary strictures untreatable by ERCP: a novel percutaneous balloon dilatation technique avoiding indwelling catheters

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate long-term patency rates of a novel percutaneous threefold balloon dilatation protocol in benign anastomotic biliary strictures.

Methods

Patients with a benign biliary stricture after hepatobiliary surgery or liver transplantation, untreatable with endoscopy, underwent a percutaneous treatment cycle consisting of a 20-min balloon dilatation session on day one, repeated on days three and five. No catheters were left behind after the last dilatation session. Technical and clinical success as well as complications were analysed. Mean primary and secondary patency times were assessed. Cumulative primary and secondary patency rates at 6 months and 1, 2 and 3 years were determined.

Results

Seventy patients underwent 135 dilatation treatment cycles (mean 1.9) with a technical success rate of 99%. Clinical success was achieved in 87% of the patients. Fifty-eight of 135 (43%) patients had minor and 15/135 (11%) had major complications. Mean primary and secondary patency times were 26 months and 46 months, respectively, with a median follow-up of 69 months. Cumulative primary patency rate at 6 months was 67%, at 1 year 56%, at 2 years 41% and at 3 years 36%. The cumulative secondary patency rate at 6 months was 83%, at 1 year 79%, at 2 years 70% and at 3 years 64%.

Conclusion

In benign anastomotic biliary strictures, a percutaneous threefold balloon dilatation treatment is effective. As long indwelling catheters are avoided, patient comfort improves.

Key Points

• Percutaneous threefold balloon dilatation treatment is effective in benign anastomotic biliary strictures.

• As indwelling catheters after dilatation are avoided, patient comfort improves.

• The dilatation protocol can be repeated efficiently in case of recurrent stricture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransaminase

AST:

Aspartate aminotransaminase

ERCP:

Endoscopic retrograde cholangiopancreatography

ESM:

Electronic supplementary material

GGT:

Gamma-glutamyltransferase

HAD:

Hepatic artery disease

OLT:

Orthotopic liver transplantation

References

  1. Gastaca M (2012) Biliary complications after orthotopic liver transplantation: a review of incidence and risk factors. Transplant Proc 44(6):1545–1549

    Article  CAS  Google Scholar 

  2. Chang JH, Lee I, Choi MG, Han SW (2016) Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation. World J Gastroenterol 22(4):1593–1606

    Article  CAS  Google Scholar 

  3. Duconseil P, Turrini O, Ewald J, Berdah SV, Moutardier V, Delpero JR (2014) Biliary complications after pancreaticoduodenectomy: skinny bile ducts are surgeons’ enemies. World J Surg 38(11):2946–2951

    Article  Google Scholar 

  4. House MG, Cameron JL, Schulick RD et al (2006) Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 243(5):571–576 discussion 576

    Article  Google Scholar 

  5. Rustagi T, Aslanian HR (2014) Endoscopic management of biliary leaks after laparoscopic cholecystectomy. J Clin Gastroenterol 48(8):674–678

    Article  Google Scholar 

  6. Dumonceau JM, Tringali A, Blero D et al (2012) Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (Esge) Clinical Guideline. Endoscopy 44(3): 277-298.

  7. Yazumi S, Yoshimoto T, Hisatsune H et al (2006) Endoscopic treatment of biliary complications after right-lobe living-donor liver transplantation with duct-to-duct biliary anastomosis. J Hepatobiliary Pancreat Surg 13(6):502–510

    Article  Google Scholar 

  8. Sharma S, Gurakar A, Jabbour N (2008) Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl 14(6):759–769

    Article  Google Scholar 

  9. Graziadei IW, Schwaighofer H, Koch R et al (2006) Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl 12(5): 718-725.

  10. Zajko AB, Sheng R, Zetti GM, Madariaga JR, Bron KM (1995) Transhepatic balloon dilation of biliary strictures in liver transplant patients: a 10-year experience. J Vasc Interv Radiol 6(1):79–83

    Article  CAS  Google Scholar 

  11. Righi D, Cesarani F, Muraro E, Gazzera C, Salizzoni M, Gandini G (2002) Role of interventional radiology in the treatment of biliary strictures following orthotopic liver transplantation. Cardiovasc Intervent Radiol 25(1):30–35

    Article  Google Scholar 

  12. Sung RS, Campbell DA, Rudich SM et al (2004) Long-term follow-up of percutaneous transhepatic balloon cholangioplasty in the management of biliary strictures after liver transplantation. Transplantation 77(1):110–115

    Article  Google Scholar 

  13. Saad WE, Saad NE, Davies MG et al (2005) Transhepatic balloon dilation of anastomotic biliary strictures in liver transplant recipients: the significance of a patent hepatic artery. J Vasc Interv Radiol 16(9):1221–1228

    Article  Google Scholar 

  14. Saad WE (2008) Percutaneous management of postoperative anastomotic biliary strictures. Tech Vasc Interv Radiol 11(2):143–153

    Article  Google Scholar 

  15. Glas L, Courbiere M, Ficarelli S, Milot L, Mennesson N, Pilleul F (2008) Long-term outcome of percutaneous transhepatic therapy for benign bilioenteric anastomotic strictures. J Vasc Interv Radiol 19(9):1336–1343

    Article  Google Scholar 

  16. Ko GY, Sung KB, Yoon HK, Kim KR, Gwon DI, Lee SG (2008) Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation. Liver Transpl 14(9):1323–1332

    Article  Google Scholar 

  17. Gwon DI, Sung KB, Ko GY, Yoon HK, Lee SG (2011) Dual catheter placement technique for treatment of biliary anastomotic strictures after liver transplantation. Liver Transpl 17(2):159–166

    Article  Google Scholar 

  18. Janssen JJ, van Delden OM, van Lienden KP et al (2014) Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures. Cardiovasc Intervent Radiol 37(6):1559–1567

    Article  Google Scholar 

  19. DePietro DM, Shlansky-Goldberg RD, Soulen MC et al (2015) Long-term outcomes of a benign biliary stricture protocol. J Vasc Interv Radiol 26(7):1032–1039

    Article  Google Scholar 

  20. Atar E, Bachar GN, Eitan M, Graif F, Neyman H, Belenky A (2007) Peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures: long-term results. Diagn Interv Radiol 13(1):39–41

    Google Scholar 

  21. Mukund A, Rajesh S, Agrawal N, Arora A, Arora A (2015) Percutaneous management of resistant biliary-enteric anastomotic strictures with the use of a combined cutting and conventional balloon cholangioplasty protocol: a single-center experience. J Vasc Interv Radiol 26(4):560–565

    Article  Google Scholar 

  22. Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14(9 Pt 2):S199–S202

    Article  Google Scholar 

  23. Singer M, Deutschman CS, Seymour CW et al (2016) The Third International Consensus Definitions For Sepsis And Septic Shock (Sepsis-3). JAMA 315(8):801–810

    Article  CAS  Google Scholar 

  24. Piardi T, Greget M, Audet M et al (2011) Biliary strictures after liver transplantation: is percutaneous treatment indicated. Ann Transplant 16(2):5–13

    Article  Google Scholar 

  25. Cantwell CP, Pena CS, Gervais DA, Hahn PF, Dawson SL, Mueller PR (2008) Thirty years’ experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes. Radiology 249(3):1050–1057

    Article  Google Scholar 

  26. Bonnel DH, Fingerhut AL (2012) Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg 203(6):675–683

    Article  Google Scholar 

  27. Giampalma E, Renzulli M, Mosconi C, Ercolani G, Pinna AD, Golfieri R (2012) Outcome of post-liver transplant ischemic and nonischemic biliary stenoses treated with percutaneous interventions: The Bologna experience. Liver Transpl 18(2):177–187

    Article  Google Scholar 

  28. Ludwig JM, Webber GR, Knechtle SJ, Spivey JR, Xing M, Kim HS (2016) Percutaneous management of benign biliary strictures with large-bore catheters: comparison between patients with and without orthotopic liver transplantation. J Vasc Interv Radiol 27(2):219–225.e1

    Article  Google Scholar 

  29. Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF (2010) Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 21(6):789–795

    Article  Google Scholar 

  30. Sunku B, Salvalaggio PR, Donaldson JS et al (2006) Outcomes and risk factors for failure of radiologic treatment of biliary strictures in pediatric liver transplantation recipients. Liver Transpl 12(5):821–826

    Article  Google Scholar 

  31. Miraglia R, Maruzzelli L, Caruso S et al (2008) Percutaneous management of biliary strictures after pediatric liver transplantation. Cardiovasc Intervent Radiol 31(5):993–998

    Article  Google Scholar 

  32. Miraglia R, Maruzzelli L, Spada M, Riva S, Luca A (2016) Long-term (>5 years) clinical and histological follow-up of pediatric liver transplant recipients after successful radiological percutaneous treatment of biliary strictures. Cardiovasc Intervent Radiol 39(2):313–314

    Article  Google Scholar 

  33. Saad WE, Davies MG, Saad NE et al (2006) Transhepatic dilation of anastomotic biliary strictures in liver transplant recipients with use of a combined cutting and conventional balloon protocol: technical safety and efficacy. J Vasc Interv Radiol 17(5):837–843

    Article  Google Scholar 

  34. Gwon DI, Ko GY, Ko HK, Yoon HK, Sung KB (2013) Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: mid-term outcomes in 68 patients. Dig Dis Sci 58(11):3270–3279

    Article  Google Scholar 

  35. Mauri G, Michelozzi C, Melchiorre F et al (2016) Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: retrospective multicentric data analysis on 107 patients. Eur Radiol 26(11):4057–4063

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Vascular and Interventional Radiology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium

    Elisabeth Dhondt, Peter Vanlangenhove, Lynn Huyck & Luc Defreyne

  2. Department of Gastroenterology and Hepatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium

    Hans Van Vlierberghe

  3. Department of Hepatobiliary Surgery, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium

    Roberto Troisi

  4. Department of Clinical Medicine, Federico II University, Naples, Italy

    Roberto Troisi

  5. Department of Pediatrics, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium

    Ruth De Bruyne

Authors
  1. Elisabeth Dhondt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Vanlangenhove
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans Van Vlierberghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Troisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ruth De Bruyne
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lynn Huyck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luc Defreyne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisabeth Dhondt.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Luc Defreyne.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

Electronic supplementary material

ESM 1

(DOCX 77 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dhondt, E., Vanlangenhove, P., Van Vlierberghe, H. et al. Benign anastomotic biliary strictures untreatable by ERCP: a novel percutaneous balloon dilatation technique avoiding indwelling catheters. Eur Radiol 29, 636–644 (2019). https://doi.org/10.1007/s00330-018-5526-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5526-8

Keywords

Search

Navigation