Skip to main content

Advertisement

SpringerLink
Log in

Treating Biliary-Enteric Anastomotic Strictures with Enteroscopy-ERCP Requires Fewer Procedures than Percutaneous Transhepatic Biliary Drains

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Biliary-enteric anastomotic strictures (AS) in long-limb surgical biliary bypass (LLBB) require percutaneous transhepatic biliary drains (PTBD), enteroscopy-assisted ERCP (E-ERCP), or surgical revision.

Aim

To compare E-ERCP and PTBD for AS treatment.

Methods

E-ERCP stricturoplasty included dilation, cautery, and stent; PTBD included balloon dilation and serial drain upsizing events.

Results

From May 2008 to October 2015, 71 patients (37 M, median age 52) had E-ERCP (n = 45) or PTBD (n = 26) for AS in Roux-en-Y hepaticojejunostomy: liver transplant (n = 28), cholecystectomy injury revision (n = 21), other (n = 13) or Whipple’s resection (n = 9). Median follow-up is 11 months (range 1–56) in 67 (94%) patients. Technical success, clinical improvement, and adverse events between E-ERCP and PTBD were similar (76% vs. 77%, p = 0.89; 82% vs. 85%, p = 0.80, and 6% vs. 5%, p = 0.60, respectively). However, E-ERCP had fewer post-procedural hospitalization days (0.2 ± 0.65 vs. 4.5±10, p = 0.0001), mean procedures (4.4 ± 6.3 vs. 9.5 ± 8, p = 0.006), and median months of treatment to resolve AS (1, range 1–22 vs. 7, range 3–23; p = 0.003). Two patients in PTBD group required surgery.

Conclusions

(1) Technical success and clinical improvement are seen in the majority of LLBB patients with biliary-enteric AS undergoing E-ERCP or PTBD. (2) E-ERCP is associated with fewer procedures, post-procedure hospitalization days, and months to resolve AS. When expertise is available, E-ERCP to identify and treat AS should be considered as an alternative to PTBD.

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

References

  1. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001;234:549–558. discussion 58–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. de Reuver PR, Rauws EA, Bruno MJ, et al. Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons. Surgery. 2007;142:1–9.

    Article  PubMed  Google Scholar 

  3. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165:9–14.

    Article  CAS  PubMed  Google Scholar 

  4. MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc. 1998;12:315–321.

    Article  PubMed  Google Scholar 

  5. Pitt HA, Miyamoto T, Parapatis SK, Tompkins RK, Longmire WP Jr. Factors influencing outcome in patients with postoperative biliary strictures. Am J Surg. 1982;144:14–21.

    Article  CAS  PubMed  Google Scholar 

  6. Pellegrini CA, Thomas MJ, Way LW. Recurrent biliary stricture. Patterns of recurrence and outcome of surgical therapy. Am J Surg. 1984;147:175–180.

    Article  CAS  PubMed  Google Scholar 

  7. Lillemoe KD, Melton GB, Cameron JL, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg. 2000;232:430–441.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. McDonald V, Matalon TA, Patel SK, et al. Biliary strictures in hepatic transplantation. J Vasc Interv Radiol. 1991;2:533–538.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Terblanche J, Allison HF, Northover JM. An ischemic basis for biliary strictures. Surgery. 1983;94:52–57.

    CAS  PubMed  Google Scholar 

  12. Zajko AB, Campbell WL, Bron KM, Schade RR, Koneru B, Van Thiel DH. Diagnostic and interventional radiology in liver transplantation. Gastroenterol Clin N Am. 1988;17:105–143.

    CAS  Google Scholar 

  13. Feller RB, Waugh RC, Selby WS, Dolan PM, Sheil AG, McCaughan GW. Biliary strictures after liver transplantation: clinical picture, correlates and outcomes. J Gastroenterol Hepatol. 1996;11:21–25.

    Article  CAS  PubMed  Google Scholar 

  14. Boraschi P, Braccini G, Gigoni R, et al. Detection of biliary complications after orthotopic liver transplantation with MR cholangiography. Magn Reson Imaging. 2001;19:1097–1105.

    Article  CAS  PubMed  Google Scholar 

  15. Egawa H, Inomata Y, Uemoto S, et al. Biliary anastomotic complications in 400 living related liver transplantations. World J Surg. 2001;25:1300–1307.

    Article  CAS  PubMed  Google Scholar 

  16. Todo S, Furukawa H, Kamiyama T. How to prevent and manage biliary complications in living donor liver transplantation? J Hepatol. 2005;43:22–27.

    Article  PubMed  Google Scholar 

  17. Braasch JW, Bolton JS, Rossi RL. A technique of biliary tract reconstruction with complete follow-up in 44 consecutive cases. Ann Surg. 1981;194:635–638.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Stefanini P, Carboni M, Patrassi N, Basoli A, de Bernardinis G, Negro P. Roux-en-Y hepaticojejunostomy: a reappraisal of its indications and results. Ann Surg. 1975;181:213–219.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Lee AY, Gregorius J, Kerlan RK Jr, Gordon RL, Fidelman N. Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries. PLoS ONE. 2012;7:e46478.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Moreira AM, Carnevale FC, Tannuri U, et al. Long-term results of percutaneous bilioenteric anastomotic stricture treatment in liver-transplanted children. Cardiovasc Interv Radiol. 2010;33:90–96.

    Article  Google Scholar 

  21. Miraglia R, Maruzzelli L, Caruso S, et al. Percutaneous management of biliary strictures after pediatric liver transplantation. Cardiovasc Interv Radiol. 2008;31:993–998.

    Article  Google Scholar 

  22. Imamine R, Shibata T, Yabuta M, et al. Long-term outcome of percutaneous biliary interventions for biliary anastomotic stricture in pediatric patients after living donor liver transplantation with Roux-en-Y hepaticojejunostomy. J Vasc Interv Radiol. 2015;26:1852–1859.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Chahal P, Baron TH, Poterucha JJ, Rosen CB. Endoscopic retrograde cholangiography in post-orthotopic liver transplant population with Roux-en-Y biliary reconstruction. Liver Transpl. 2007;13:1168–1173.

    Article  PubMed  Google Scholar 

  25. Sanada Y, Mizuta K, Yano T, et al. Double-balloon enteroscopy for bilioenteric anastomotic stricture after pediatric living donor liver transplantation. Transpl Int. 2011;24:85–90.

    Article  PubMed  Google Scholar 

  26. Koornstra JJ. Double balloon enteroscopy for endoscopic retrograde cholangiopancreaticography after Roux-en-Y reconstruction: case series and review of the literature. Neth J Med. 2008;66:275–279.

    CAS  PubMed  Google Scholar 

  27. Kawano Y, Mizuta K, Hishikawa S, et al. Rendezvous penetration method using double-balloon endoscopy for complete anastomosis obstruction of hepaticojejunostomy after pediatric living donor liver transplantation. Liver Transpl. 2008;14:385–387.

    Article  PubMed  Google Scholar 

  28. Kamei H, Imai H, Onishi Y, et al. Considerable risk of restenosis after endoscopic treatment for hepaticojejunostomy stricture after living-donor liver transplantation. Transpl Proc. 2015;47:2493–2498.

    Article  CAS  Google Scholar 

  29. Azeem N, Tabibian JH, Baron TH, et al. Use of a single-balloon enteroscope compared with variable-stiffness colonoscopes for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis. Gastrointest Endosc. 2013;77:568–577.

    Article  PubMed  Google Scholar 

  30. Saad WE, Davies MG, Saad NE, et al. 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. 2006;17:837–843.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  32. Shah RJ, Smolkin M, Yen R, et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc. 2013;77:593–600.

    Article  PubMed  Google Scholar 

  33. Itokawa F, Itoi T, Ishii K, Sofuni A, Moriyasu F. Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection. Dig Endosc. 2014;26:136–143.

    Article  PubMed  Google Scholar 

  34. Misra S, Melton GB, Geschwind JF, Venbrux AC, Cameron JL, Lillemoe KD. Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: a decade of experience. J Am Coll Surg. 2004;198:218–226.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Hazem Hammad, Brian C. Brauer & Raj J. Shah

  2. Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Maximiliano Smolkin

  3. Division of Gastroenterology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA

    Joshua Obuch

  4. Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Robert Ryu

Authors
  1. Hazem Hammad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian C. Brauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maximiliano Smolkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joshua Obuch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raj J. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raj J. Shah.

Ethics declarations

Conflict of interest

Dr. Shah is on an advisory board for Olympus, Inc. No other authors have disclosures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hammad, H., Brauer, B.C., Smolkin, M. et al. Treating Biliary-Enteric Anastomotic Strictures with Enteroscopy-ERCP Requires Fewer Procedures than Percutaneous Transhepatic Biliary Drains. Dig Dis Sci 64, 2638–2644 (2019). https://doi.org/10.1007/s10620-019-05670-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-05670-y

Keywords

Search

Navigation