Hepaticojejunostomy Stricture Research Articles

Intraoperative Dilatation and Air-Tight Testing of the Hepaticojejunostomy: A New Technique.

To evaluate the effect of creating an air-tight anastomosis and intraoperative dilatation of the hepaticojejunostomy (HJ) in reducing the early and long-term complications. Interventional study. Department of Surgery, King Saud University, Riyadh, between March 2008 and January 2016. After completion of HJ, the anastomosis was tested for air-tightness, and dilated with Kelly clamp in all patients undergoing the procedure. The anastomosis was reinforced with extra suture in cases of air leak. Comparison was performed between the patients who underwent HJ by the same surgeon, after and before the new technique. Sixty-seven patients underwent HJ during the study period. Air leaks from HJ were observed in 3 patients before anastomotic dilatation. The anastomosis was reinforced in these patients. No air leak was observed after dilatation of the anastomosis. There was no postoperative bile leak in any patient. However, during the follow-up 3 patients presented with recurrent cholangitis and stricture formation at the HJ site required surgical revision. The new technique had significantly reduced the rate of bile leak (p=0.029) and stricture (p=0.037) at the site of HJ when compared with patients who underwent HJ without the new technique. Creation of air-tight HJ anastomosis has completely eliminated the postoperative bile leak and reduced the rate of HJ stricture formation. The addition technique resulted in insignificant prolongation of operative time. There was no technique related complication.

Surgical revision of benign hepaticojejunostomy stricture using a robotic system (with video)

Surgical revision of benign hepaticojejunostomy stricture using a robotic system (with video)

BIODEGRADABLE BILIARY STENTS: A NEW APPROACH FOR THE MANAGEMENT OF HEPATICOJEJUNOSTOMY STRICTURES FOLLOWING BILE DUCT INJURY. PROSPECTIVE STUDY.

ABSTRACTBackground:Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. Aim: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. Methods:In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. Results:In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. Conclusion:The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy.

Abstract No. 608 - Recanalization of a post transplant hepaticojejunostomy stricture in a 13 month old child with an RF wire—success after all other measures failed

• To discuss the clinical course leading up to the hepaticojejunostomy occlusion and risks involved with repeat surgical intervention. • To describe prior failed attempts and subsequent successful recanalization via a rendezvous procedure with gastroenterology. • To bring light to a technology that may become useful in similar situations in the future. • There have been a few successful hepaticojejunostomy recanalization procedures described in the literature in recent years with similar techniques, but none described in a patient of this age with this particular technology or rendezvous approach. • This is a patient with congenital biliary atresia who underwent a Kasai portoenterostomy at 3 months of age. This was complicated by liver failure, failure to thrive, cirrhosis and portal hypertension and subsequent bleeding esophageal varices. • He then had a left lobe orthotopic liver transplant at the age of 8 months with difficult vascular and biliary anastamoses • At 11 months of age, he developed failure to thrive again with elevated bilirubin and biliary obstruction. • Conventional wire and catheter techniques to cross the occlusion were unsuccessful either percutaneously via IR or endoscopically via GI after 4 attempts resulting in multiple false tracts. • A rendezvous procedure with GI and the use of an RF wire facilitated recanalization of the occlusion, obviating need for surgical intervention. • After pre-angioplasty, a covered stent was placed across the anastomosis and percutaneous access was removed. • Hepaticojejunostomy stenosis/occlusion is a not uncommon problem in the setting of liver transplant or other periportal surgeries requiring hepaticojejunal anastomosis. • The use of the RF wire via a rendezvous procedure provided a controlled and calculated method of HJ recanalization in this infant when all other options were exhausted, who otherwise would have had to return to surgery. • Although not yet common, this rendezvous procedure, employing the RF wire technology, is an option to consider when encountering similar difficult biliary occlusions in either adults or children.

Considerable Risk of Restenosis After Endoscopic Treatment for Hepaticojejunostomy Stricture After Living-Donor Liver Transplantation

BackgroundThere are few reports on the short- and long-term follow-up of endoscopic retrograde cholangiography (ERC) in adult patients with hepaticojejunostomy (HJS) stricture after living-donor liver transplantation (LDLT). MethodsNine LDLT recipients underwent ERC with the use of double-balloon endoscopy (DBE) for HJS stricture at Nagoya University Hospital. We assessed the rate of reaching biliary anastomosis, procedure success rate, procedure duration, complications, improvement in liver function test results, and biliary anastomosis patency. ResultsIn total, 19 ERC procedures with the use of DBE were performed for 9 adult LDLT recipients with HJS stricture from June 2006 to September 2014. Balloon dilation with the use of DBE was successfully performed in 5 of the 9 patients during the 1st procedure. Of the 4 patients in whom DBE-ERC failed to be completed, 3 patients underwent 2nd procedures successfully. Liver function test results were significantly improved in the successful cases. Four patients underwent 2nd DBE-ERC for stricture recurrence at a mean time of 2.3 years after the 1st successful procedure. Of those, 2 patients required 3rd procedures for stricture recurrence after the 2nd procedure. ConclusionsDBE-ERC is promising as a treatment for HJS stricture in adult LDLT recipients in the short term. However, the DBE-ERC procedure may have a considerable risk of restenosis.

Benign Hepaticojejunostomy Stricture: Not Amenable to Endoscopy/Percutaneous Transhepatic Biliary Drainage—What to do Next?

Question: A 41-year-old woman presented with a 1-year history of recurrent cholangitis due to a hepaticojejunostomy (HJ) stricture. Two years earlier, she had undergone laparoscopic cholecystectomy for acute calculus cholecystitis. Her cholecystectomy was complicated by a common bile duct injury which required subsequent HJ. An attempt at endoscopic retrograde cholangiopancreatography using single balloon enteroscopy was unsuccessful in reaching the HJ anastomosis due to sharp jejunal angulation. She then underwent ultrasound-guided percutaneous bile duct access via segment 3 duct and subsequently segment 8. Her cholangiogram showed a tight HJ stricture. Despite multiple attempts, a guide wire could not be negotiated across the stricture (Figure A, B). What should be the next step in management in this case? Is surgery the only option? Look on page 1342 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. She underwent percutaneous ultrasound-guided and fluoroscopic guided puncture of the superficial unfixed jejunal loop proximal to HJ with an 18-G needle (Figure C) and a sheath was placed. With a catheter–guidewire combination, the HJ site was accessed and stricture negotiated. The guidewire was snared through the percutaneous transhepatic biliary drainage access via segment 3 (Figure D). Subsequently, the stricture was dilated through segment 3 with a 10-mm balloon (Figure E). Then, 10-Fr Malecot catheters were placed via segment 3 and segment 8 ducts (Figure F). The patient is now under follow-up and will undergo progressive catheter upsizing via percutaneous transhepatic biliary drainage every 3 months for 1 year. Conventionally, treatment of HJ strictures consists of nonsurgical and surgical methods. Nonsurgical techniques are either by endoscopic1Devière J. Nageshwar Reddy D. Püspök A. et al.Successful management of benign biliary strictures with fully covered self-expanding metal stents.Gastroenterology. 2014; 147: 385-395Abstract Full Text Full Text PDF PubMed Scopus (167) Google Scholar or percutaneous route using balloon dilatation or stent placement.2Cantwell C.P. Pena C.S. Gervais D.A. et al.Thirty years’ experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes.Radiology. 2008; 249: 1050-1057Crossref PubMed Scopus (55) Google Scholar Surgical methods vary from redo HJ to a number of special techniques such as biliary access loops to facilitate future endoscopic intervention. Fontein et al3Fontein D.B. Gibson R.N. Collier N.A. et al.Two decades of percutaneous transjejunal biliary intervention for benign biliary disease: a review of the intervention nature and complications.Insights Imaging. 2011; 2: 557-565Crossref PubMed Google Scholar previously described success and effectiveness of percutaneous transjejunal biliary intervention for HJ stricture in 63 patients. Six of these patients underwent percutaneous puncture of an unfixed jejunal loop which allowed access through the stricture as in our case. percutaneous transjejunal biliary intervention is technically feasible, safe and can avoid major surgery.

Surgical revision of hepaticojejunostomy strictures after pancreatectomy.

After pancreatic surgery hepaticojejunostomy (HJ) stricture is a rare condition. Usually, management is conservative, while operative revision ("redo") is only rarely performed. This was an observational cohort design that analyzed the outcome of patients who had a surgical revision of HJ strictures after pancreatic surgery at a specialized pancreatic center. During a period of 7 years from January 2004 until December 2010, 887 patients underwent pancreaticoduodenectomy (PD) or HJ. Among this patient population, 3 % (23/887) underwent a redo of the HJ secondary to stricture formation. Major symptoms of HJ strictures were recurrent cholangitis in 91 % (21/23) and jaundice in 39 % (9/23). The median time from the index operation until redo of the HJ was 16 ± 27 months. The median survival of patients with malignancy after redo of the HJ was 45 ± 67 months. Major surgical morbidity was 9 % (2/23), and mortality was 0 % (0/23). In 78 % (18/23), there were no further episodes of cholangitis after a median follow of 49 ± 73 months, while none of the patients with redo of the HJ developed a restenosis of the HJ. Surgical revision (redo) of HJ strictures can be safely performed by an experienced pancreatic surgeon with a low morbidity without mortality with good long-term results.

Laparoendoscopic approach for refractory Roux‐en‐Y hepaticojejunostomy stricture in an acute setting: A unique case and technique

Roux-en-Y hepaticojejunostomy stricture is a substantial problem that develops in 10%-30% of patients and requires frequent intervention. Although endoscopic/percutaneous approaches are preferred, especially for refractory stricture, open surgical reconstruction remains the gold standard. However, such an operation may be highly challenging. The recently developed covered, self-expanding metallic stent is a useful option for such difficult cases. We present a case of recurrent Roux-en-Y hepaticojejunostomy stricture complicated by densely packed intrahepatic stones and suppurative cholangitis with failed percutaneous biliary draining. Enteroscopic manipulations were unfeasible, and the case was successfully managed by the laparoendoscopic approach. If treating surgeons have the necessary expertise, this technique may be considered in such difficult scenarios.

Hepatolithiasis after Hepaticojejunostomy: Ascaris lumbricoides in the Biliary Tract

Biliary ascariasis is a common problem in Third World countries and other underdeveloped areas of the world. Ascaris lumbricoides migrates into the biliary tree, where it is apparent commonly on diagnostic imaging. We present a unique case of a patient with chronic right upper quadrant abdominal pain, massive hepatolithiasis, and stricture of a previous hepaticojejunostomy in whom ascariasis was found. A 28-year-old female presented to the emergency department with right upper quadrant abdominal pain, syncope, and seizure-like activity. She was found by magnetic resonance cholangiopancreatography to have cholangitis, choledocholithiasis, and bile duct stricture. After multiple radiographic studies, she was taken to the operating room for revision of a hepaticojejunostomy performed 10 years previously. Ascaris lumbricoides was found in the right intrahepatic bile duct, that had not been identified by multiple radiologic modalities. The worm was sent to the pathology department for identification. A Fogarty catheter was passed into the hepatic ducts for successful stone extraction. The hepaticojejunostomy was revised, with catheter placement in the Roux limb to accommodate radiologic stone extraction as necessary. Post-operatively, she was given a single dose of albendazole and discharged on hospital day 19. The worm was likely the nidus for the stricture and stone formation. Surgical exploration of the biliary tree was required to diagnose and treat her condition accurately. This case is unique in that typical means of diagnosis failed to identify the causative agent of hepatolithiasis because of the prior Roux-en-Y hepaticojejunostomy.

4:02 PM Abstract No. 107 - Outcomes of viabil covered stent placement for treatment of hepaticojejunostomy strictures

Purpose Viabil ePTFE/FEP-covered biliary stents have shown excellent patency and reported migration rates of 0.3% based on early clinical studies in patients with malignant biliary strictures. Strictures at surgical hepaticojejunostomy sites present a particular challenge because of the short landing zone within the duct. The purpose of this study is to assess outcomes of Viabil stent placement for hepaticojejunostomy strictures. Materials and Methods We retrospectively reviewed our records for Viabil stent placement procedures performed between Feb. 2006 and Sept. 2012 and included in this study patients who had undergone Viabil placement to treat hepaticojejunostomy strictures. The cause of stricture and follow-up clinical and radiographic data were collected. Results Of a total of 90 Viabil placement procedures in 88 patients, 13 patients underwent 14 interventions in which a Viabil stent was deployed across a hepaticojejunostomy for malignant (n=12) and benign (n=1) biliary strictures. The following sizes were used: 8×4 (n=5), 8×6 (n=6), 10×6 (n=4), 10×8 (n=1), and 10×10 (n=1) (mm diameter × cm length). One patient underwent stent placement in a double-barrel configuration, and another underwent stent placement in a Y configuration. During followup (mean 115 d, range 0-404 d), three stents (21% of placements), all 8x4 size, migrated: one on the day of placement and two detected 200 and 340 days later. There were no complications from stent passage. Three patients required reintervention for occluded 10 mm stents (21% of placements): One with benign stricture underwent stent removal (381 d), and two underwent biliary drain placement (137 and 155 d). One of the stent occlusion patients had Viabil stents placed in a Y configuration. Conclusion Viabil placement for hepaticojejunostomy strictures is technically feasible but is associated with higher rates of stent migration (21%) than described in the literature. As the migrated stents were only 4 cm long, use of longer fenestrated stents, with greater apposition to the hepatic ducts, may be helpful to avoid that complication.

Long-term Results of Percutaneous Biliary Balloon Dilation Treatment for Benign Hepaticojejunostomy Strictures: Are Repeated Balloon Dilations Necessary?

PurposeTo determine the safety, efficacy, and long-term results of percutaneous biliary balloon dilation (PBBD) of benign hepaticojejunostomy strictures and evaluate the necessity of repeated PBBD in this setting. Materials and MethodsPBBD was performed after traversing hepaticojejunostomy strictures in 89 patients (40 male, 49 female; age range, 19–84 y; mean age ± SD, 54.5 y ± 14.0), who were divided into three groups: group I (one satisfactory initial PBBD; n = 41), group II (two or more PBBDs with satisfactory initial PBBD; n = 33), and group III (two or more PBBDs without satisfactory PBBD; n = 15). Groups I and II were randomized. The primary outcome measure was the absence of clinical biliary obstruction symptoms at 24 months. Secondary outcome measures included technical and clinical success, primary and secondary patency, major complications, and mortality. Categoric variables were compared between groups I and II. ResultsProcedure-related mortality and major morbidity rates were 0% and 5.6%, respectively. Mean primary and secondary patency durations were 45.3 months ± 2.2 and 71.3 months ± 15.4, respectively. The follow-up period was 36.4 months ± 15.1. The primary outcome measure was achieved in 73% of patients. Technical and clinical success rates (secondary outcome measures) were 97.8% and 84.3%, respectively. Repeated PBBD procedures were not satisfactory in 16.9% of patients. No significant differences in categoric variables were observed between groups I and II. ConclusionsPBBD of benign hepaticojejunostomy strictures is a safe and effective procedure. Repeated PBBD is not required when the first procedure is successful.

The Heineke-Mikulicz Principle for Hepaticojejunostomy Stricture

Benign anastomotic stricture after hepaticojejunostomy is one of the serious complications of biliary surgery. If left untreated, jaundice, cholangitis, or cirrhosis may develop. A 58-year-old male patient was admitted with benign hepaticojejunostomy stricture. The patient initially underwent an endoscopic retrograde cholangiography using double-balloon enteroscope, which was unsuccessful due to the sharp angle between the jejunal limb and the biliary tree. It was decided to perform surgery. During the operation, we performed Heineke-Mikulicz strictureplasty to the narrowed anastomosis. Patient's postoperative course was uneventful. At the end of followup, for 18 months, his liver enzymes were within normal ranges, and the ultrasound examination showed a patent hepaticojejunostomy anastomosis. The simplicity of the technique and the promising result support the applicability of the Heineke-Mikulicz principle in suitable cases as an alternative treatment approach for hepaticojejunostomy strictures.

Transhepatic metallic stenting for hepaticojejunostomy stricture following laparoscopic cholecystectomy biliary injury: A case of successful 20 years follow-up

Laparoscopic cholecystectomy is still associated with a considerable rate of biliary injuries and related strictures. Advances in interventional endoscopy and percutaneous techniques have made stenting a preferred treatment modality for the management of these strictures. We report successful 20 years of follow-up of a case of trans-hepatic metallic stenting (2 Gianturco® prostheses, 5 cm long, 2 cm in diameter) done for stenosed hepatico-jejunostomy anastomosis after laparoscopic CBD injury. Percutaneous transhepatic stenting and long-term placement of metallic stents need to be re-evaluated as a minimally invasive definitive treatment option for benign biliary strictures in patients with altered anatomy such as hepatico-jejunostomy or in whom re-operation involves high risk.

Changing clinical profile, management strategies and outcome of patients with biliary tract injuries at a tertiary care center in Sri Lanka

Biliary tract injuries are mostly iatrogenic. Related data are limited in developing countries. There are lessons to be learned by revisiting the clinical profiles, management issues and outcome of patients referred to a tertiary care center in Sri Lanka, compared with the previous data from the same center published in 2006. Such a review is particularly relevant at a time of changing global perceptions of iatrogenic biliary injuries. This study aimed to analyze and compare the changes in the injury pattern, management and outcome following biliary tract injury in a Sri Lankan study population treated at a tertiary care center. A retrospective analysis was made of 67 patients treated between May 2002 and February 2011. The profiles of the last 38 patients treated from October 2006 to February 2011 were compared with those of the first 29 patients treated from May 2002 to September 2006. Definitive management options included endoscopic biliary stenting, reconstructive hepaticojejunostomy with creation of gastric access loops, and biliary stricture dilation. Post-treatment jaundice, cholangitis and abdominal pain needing intervention were considered as treatment failures. In the 67 patients, 55 were women and 12 men. Their mean age was 40.6 (range 19-80) years. Five patients had traumatic injuries. Thirty-seven injuries (23 during the second study period) were due to laparoscopic cholecystectomy and 25 (10 during the second study period) to open cholecystectomy. The identification rate of intra-operative injury was 19% in the laparoscopic group and 8% in the open group. Bismuth type I, II, III and IV injuries were seen in 18, 18, 15 and 12 patients, respectively. Endoscopic stenting was the definitive treatment in 20 patients. In 35 patients who had hepaticojejunostomy, 33 underwent creation of the gastric access loop. Twenty-two reconstructions were performed during the second study period. A gastric access loop was used for endotherapy in three patients with anastomotic occlusion at the site of hepaticojejunostomy. The overall outcome was satisfactory in the majority of patients. There were four injury-related deaths. Biliary tract injuries associated with laparoscopic cholecystectomy have become the most frequent cause of biliary injury management at our center. Although endotherapy was useful in selected patients, in the majority, surgical reconstruction with hepaticojejunostomy was required as the definitive treatment. Creation of the gastric access loop was found to be a useful adjunct in the management of hepaticojejunostomy strictures.

Laparoscopic Revisional Hepaticojejunostomy for Biliary Stricture After Open Repair Following Common Bile Duct Injury: A Case Report

Incidence of bile duct injury has been reported more frequently following laparoscopic cholecystectomy. A 43-year-old female with a past medical history of laparoscopic cholecystectomy that was converted to open because of a common bile duct injury now presents with a stenosis at the hepaticojejunostomy that is causing recurrent cholangitis episodes. After the lysis of adhesions and dissection of the anastomotic area, a stricture was identified. The authors exposed and redid the hepaticojejunostomy with 4-0 Monocryl sutures without tension. The follow-up period was unremarkable. No leaks were documented, and the patient was discharged home on postoperative day 3. After percutaneous or endoscopic procedure failure for the treatment of hepaticojejunostomy strictures, the laparoscopic redo anastomosis is safe and feasible when performed by surgeons who are strongly trained in advanced laparoscopic surgery.

Endoscopic and retrograde cholangiographic appearance of hepaticojejunostomy strictures: A practical classification

To study the endoscopic and radiological characteristics of patients with hepaticojejunostomy (HJ) and propose a practical HJ stricture classification. In a retrospective observational study, a balloon-assisted enteroscopy (BAE)-endoscopic retrograde cholangiography was performed 44 times in 32 patients with surgically-altered gastrointestinal (GI) anatomy. BAE-endoscopic retrograde cholangio pancreatography (ERCP) was performed 23 times in 18 patients with HJ. The HJ was carefully studied with the endoscope and using cholangiography. The authors observed that the hepaticojejunostomies have characteristics that may allow these to be classified based on endoscopic and cholangiographic appearances: the HJ orifice aspect may appear as small (type A) or large (type B) and the stricture may be short (type 1), long (type 2) and type 3, intrahepatic biliary strictures not associated with anastomotic stenosis. In total, 7 patients had type A1, 4 patients A2, one patient had B1, one patient had B (large orifice without stenosis) and one patient had type B3. This practical classification allows for an accurate initial assessment of the HJ, thus potentially allowing for adequate therapeutic planning, as the shape, length and complexity of the HJ and biliary tree choice may mandate the type of diagnostic and therapeutic accessories to be used. Of additional importance, a standardized classification may allow for better comparison of studies of patients undergoing BAE-ERCP in the setting of altered upper GI anatomy.

Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation

Endoscopic treatment has largely replaced surgery as the initial treatment for biliary strictures following living donor liver transplantation; however, this treatment is nearly impossible in patients who have previously undergone hepaticojejunostomy (HJ). We therefore retrospectively evaluated the efficacy of percutaneous transhepatic treatment in patients who developed HJ strictures following living donor liver transplantation. Percutaneous transhepatic biliary drainage and subsequent balloon dilation of biliary strictures were performed on 83 patients. Serial exchanges of drainage tubes with larger diameters up to 14 Fr were performed at 4-week intervals. Drainage tubes were removed if follow-up cholangiography revealed fluent passage of the contrast medium without recurrence of symptoms or changes in the biochemical findings. The clinical outcome, tube independence rate, and patency rate following drainage tube removal were retrospectively evaluated. Except for 2 patients who had failed negotiation of biliary strictures, clinical success was achieved in all 81 patients following percutaneous transhepatic treatment, and the drainage tubes were removed from 76 (93.8%) of these 81 patients. Tubes were removed 11.2 +/- 7.4 months after initial percutaneous transhepatic biliary drainage. The recurrence rate at a mean of 36.0 +/- 26.2 months following drainage tube removal was 15.8%. One- and three-year primary patency rates were 95.3% +/- 2.7% and 80.9% +/- 5.2%, respectively. In conclusion, percutaneous transhepatic treatment is an effective alternative treatment for HJ strictures following living donor liver transplantation. However, further research will be required in order to minimize the duration of treatment and the stricture recurrence rate following tube removal.

Percutaneous treatment of benign bile duct strictures

Purpose To evaluate long-term results of treatment of benign bile duct strictures. Materials and methods From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27–77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. Results Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. Conclusion Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.

Percutaneous balloon dilatation for benign hepaticojejunostomy strictures.

Percutaneous balloon dilatation of biliary tract strictures is generally accepted as a safe and inexpensive procedure. The effectiveness in selected groups of patients remains under discussion. The purpose of this study was to evaluate the results of percutaneous balloon dilatation in patients with a benign stricture of a hepaticojejunostomy. Fifteen patients with a benign stricture of a hepaticojejunostomy were examined between 1993 and July 1997. An ultrasound-guided percutaneous transhepatic cholangiography (PTC) procedure was performed, followed by a balloon dilatation. Follow-up was performed prospectively by outpatient visits and laboratory testing. Percutaneous dilatation was successful in 14 patients. Three patients developed a recurrence. In one of these patients, the procedure was repeated successfully. Gastrointestinal bleeding occurred in one patient. The success rate for balloon dilatation in this group of patients was 73% after a mean follow-up of 30 months. When the procedure was repeated, the success rate was 80% after a mean follow-up of 33 months. Percutaneous balloon dilatation for benign hepaticojejunostomy strictures is feasible in the majority of patients and produces acceptable medium-term to long-term results. Advantages are its minimal invasive character and the fact that all options remain open in case of failure.