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Endoscopic Balloon Dilation for Benign Bilioenteric Stricture: Outcomes and Factors Affecting Recurrence

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Abstract

Background

Balloon dilation (BD) is a simple, effective procedure for postoperative benign bilioenteric strictures (BBESs). Factors associated with BBES recurrence after endoscopic BD have not been studied adequately. This study examined the outcomes and 1-year recurrence factors in patients with BBES who underwent endoscopic BD.

Methods

Patients who underwent endoscopic BD as an initial treatment between April 2008 and March 2017 were retrospectively assessed. The median time to recurrence of BBES (RBBES) and recurrence factors were evaluated.

Results

The study group comprised 55 patients (median age 72 years). The rate of RBBES was 52.7% (29/55), and the median time to RBBES was 2.78 years (95% confidence interval [CI] 1.17–4.40). RBBES was observed in 32.7% (18/55) within 1 year after endoscopic BD. The significant factors associated with recurrence within 1 year, revealed by multivariate analysis, were: postoperative bile leak (p = 0.001; hazard ratio [HR] 10.94; 95% CI 2.47–48.39); BBES onset within 6 months, postoperatively (p = 0.013; HR 6.18; 95% CI 1.46–26.21); no intrahepatic stones (p = 0.049; HR 3.05; 95% CI 1.01–9.22); and remaining balloon waist (p = 0.005; HR 5.71; 95% CI 1.69–19.31). The median time to RBBES was significantly shorter in patients with these recurrence factors (0.88 years vs. not reached, p = 0.004). Patients exhibiting at least two recurrence factors were significantly more likely to experience recurrence (p < 0.001).

Conclusion

Endoscopic BD is effective for BBES, especially for patients with no recurrence factors. Consideration of endoscopic BD and additional treatment may be necessary for patients with recurrence factors.

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Acknowledgments

The authors thank Olympus Medical Systems (Tokyo, Japan) for providing the prototype instruments used in this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0375, Japan

    Hiroshi Yamauchi, Mitsuhiro Kida, Eiji Miyata, Kosuke Okuwaki, Tomohisa Iwai, Naoki Minato, Masayoshi Tadehara, Masafumi Watanabe, Hiroshi Imaizumi & Wasaburo Koizumi

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  1. Hiroshi Yamauchi
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  2. Mitsuhiro Kida
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  3. Eiji Miyata
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  4. Kosuke Okuwaki
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  5. Tomohisa Iwai
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  6. Naoki Minato
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  7. Masayoshi Tadehara
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  8. Masafumi Watanabe
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  9. Hiroshi Imaizumi
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Correspondence to Hiroshi Yamauchi.

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Yamauchi, H., Kida, M., Miyata, E. et al. Endoscopic Balloon Dilation for Benign Bilioenteric Stricture: Outcomes and Factors Affecting Recurrence. Dig Dis Sci 64, 3557–3567 (2019). https://doi.org/10.1007/s10620-019-05811-3

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  • DOI: https://doi.org/10.1007/s10620-019-05811-3

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