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Double-balloon endoscopy-assisted treatment of hepaticojejunostomy anastomotic strictures and predictive factors for treatment success

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Abstract

Background

Endoscopic management of hepaticojejunostomy anastomotic strictures is technically demanding due to surgically altered anatomy. The promise of double-balloon endoscope-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) has been reported in this setting. No large study has examined long-term outcomes of this new treatment modality and predictive factors for the stricture resolution.

Methods

We included 102 patients who received DB-ERCP for a hepaticojejunostomy anastomotic stricture between 2008 and 2018. Balloon dilation was performed as a first-line treatment, and plastic stent(s) were placed for refractory cases. Potential predictive factors for the stricture resolution were examined using multivariable logistic regression analyses.

Results

DB-ERCP was technically successful in 91 patients (89.2%). Overall, stricture resolution was achieved in 70 patients (76.9%) with a median follow-up period of 30.9 months (range 1–118.5 months). Among 64 patients (71.9%) who underwent successful re-canalization via balloon dilation, anastomotic stricture recurred in 22 patients (34.4%). In cases with refractory or recurrent stricture after balloon dilation, 20 patients (52.6%) underwent stricture resolution via plastic stent placement, and the recurrence was observed in two patients (10%). Post-operative time to DB-ERCP of > 12 months and the scar-like appearance around the anastomosis were associated with a higher rate of stricture resolution (odds ratios, 5.59 [95% CI 1.69–18.5] and 5.22 [95% CI 1.29–21.1], respectively).

Conclusions

Treatment of hepaticojejunostomy anastomotic strictures via DB-ERCP was technically feasible, providing a reasonably high rate of stricture resolution. Alternative treatment should be explored for refractory cases.

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Author notes

  1. Tatsuya Sato and Hirofumi Kogure have contributed equally as co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Tatsuya Sato, Hirofumi Kogure, Yousuke Nakai, Kazunaga Ishigaki, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Naminatsu Takahara, Tsuyoshi Hamada, Suguru Mizuno, Atsuo Yamada, Minoru Tada, Hiroyuki Isayama & Kazuhiko Koike

  2. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Hiroyuki Isayama

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  1. Tatsuya Sato
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  2. Hirofumi Kogure
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Correspondence to Yousuke Nakai.

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Drs. Tatsuya Sato, Hirofumi Kogure, Yousuke Nakai, Kazunaga Ishigaki, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Naminatsu Takahara, Tsuyoshi Hamada, Suguru Mizuno, Atsuo Yamada, Minoru Tada, Hiroyuki Isayama, and Kazuhiko Koike have no conflict of interest or financial ties to disclose.

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Sato, T., Kogure, H., Nakai, Y. et al. Double-balloon endoscopy-assisted treatment of hepaticojejunostomy anastomotic strictures and predictive factors for treatment success. Surg Endosc 34, 1612–1620 (2020). https://doi.org/10.1007/s00464-019-06924-6

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