European Radiology

, Volume 29, Issue 2, pp 636–644 | Cite as

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

  • Elisabeth Dhondt
  • Peter Vanlangenhove
  • Hans Van Vlierberghe
  • Roberto Troisi
  • Ruth De Bruyne
  • Lynn Huyck
  • Luc Defreyne



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


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.


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%.


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.


Bile ducts Stricture Dilatation 



Alkaline phosphatase


Alanine aminotransaminase


Aspartate aminotransaminase


Endoscopic retrograde cholangiopancreatography


Electronic supplementary material




Hepatic artery disease


Orthotopic liver transplantation



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

Compliance with ethical standards


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.


• prospective

• observational

• performed at one institution

Supplementary material

330_2018_5526_MOESM1_ESM.docx (77 kb)
ESM 1 (DOCX 77 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Elisabeth Dhondt
    • 1
  • Peter Vanlangenhove
    • 1
  • Hans Van Vlierberghe
    • 2
  • Roberto Troisi
    • 3
    • 4
  • Ruth De Bruyne
    • 5
  • Lynn Huyck
    • 1
  • Luc Defreyne
    • 1
  1. 1.Department of Vascular and Interventional RadiologyGhent University HospitalGentBelgium
  2. 2.Department of Gastroenterology and HepatologyGhent University HospitalGentBelgium
  3. 3.Department of Hepatobiliary SurgeryGhent University HospitalGentBelgium
  4. 4.Department of Clinical MedicineFederico II UniversityNaplesItaly
  5. 5.Department of PediatricsGhent University HospitalGentBelgium

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