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

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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.

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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

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Correspondence to Raj J. Shah.

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

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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

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

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