Persistent Stricture Research Articles

Long-term outcomes of fully covered self-expandable metal stents for refractory biliary strictures after living donor liver transplantation: a retrospective study at a tertiary center.

Endoscopic multiple plastic stents are an established first-line treatment for anastomotic biliary stricture (ABS) management after liver transplantation (LT). Fully covered self-expandable metallic stents (FCSEMSs) have recently been used with favorable outcomes, but long-term treatment outcomes remain an issue for ABS. We evaluated the long-term outcomes of FCSEMS for the management of refractory ABS after LT. We reviewed the prospectively collected and maintained endoscopic retrograde cholangiography database at Asan Medical Center to retrieve consecutive post-LT ABS cases that underwent an endoscopic FCSEMS placement between August 2009 and August 2019 after MPS placement failure. A total of 34 patients were enrolled in this study. Technical success had been achieved in all subjects (100%). The median stent placement duration was 3.1months (IQR 2.7-6.1). Stricture resolution was achieved in 26 patients (clinical success 76.5%, 95% confidence interval 62-91). Early adverse events developed in 3 patients (8.8%), including distal stent migration. Late adverse events occurred in 9 patients (26.5%), including cholangitis (n = 7, 20.6%) and asymptomatic distal stent migration (n = 2, 5.9%). The median follow-up period was 57.9months (IQR 51.9-64.3). Stricture recurrence occurred in 3 of 26 patients who achieved clinical success (11.5%). FCSEMS placement appears to be an effective and advisable intervention for refractory ABS as it can provide persistent stricture improvement over the long-term.

Sonographic Diagnosis of Carpal Tunnel Syndrome.

Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn from it. It focuses on the semiquantitative sonographic parameters of nerve compression. Nerve lesions and persistent strictures can be visualized and clearly localized. In recurrent disease, the primary focus is to dynamically exclude postoperative scarring, which results in a reduction of nerve gliding.

Long-term outcomes of fully covered self-expandable metal stents versus plastic stents in chronic pancreatitis

Chronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists. Fully covered self-expandable metal stents (FC-SEMS) has been tried in CP patients, but the efficacy and safety are still controversial. Thus, we aim to compare the long-term clinical efficacy of FC-SEMS vs. plastic stent placement in persistent MPD strictures secondary to CP. Between 2007 and 2018, 80 chronic pancreatitis patients (58 males, median age 49 years), who underwent endoscopic placement of FC-SEMS (n = 26) and plastic stent (n = 54) for persistent MPD strictures after at least 3 months of initial single plastic stenting, were retrospectively analyzed during a median follow-up duration of 33.7 months. As a result, MPD stricture resolution rate was statistically higher in FC-SEMS group (87.0% vs. 42.0%, p < 0.001). Although immediate complications occurred similarly (38.5% vs. 37.0%, p = 0.902), spontaneous migration (26.9%) and de novo strictures (23.1%) were pronounced delayed complications in FC-SEMS group. Pain relief during follow-up was significantly higher in FC-SEMS group (76.9% vs. 53.7%, p = 0.046). The total procedure cost was similar in both groups ($1,455.6 vs. $1,596.9, p = 0.486). In comparison with plastic stent, FC-SEMS placement for persistent MPD strictures had favorable long-term clinical efficacy, with its typical complications like spontaneous migration and de novo strictures.

Use of Lumen-Apposing Metal Stents for Inflammatory Bowel Disease-Related Strictures at a Pediatric Center: A Case Series

Use of Lumen-Apposing Metal Stents for Inflammatory Bowel Disease-Related Strictures at a Pediatric Center: A Case Series

S1386 Periampullary Duodenal Diverticulitis and Common Bile Duct Stricture

INTRODUCTION: Periampullary duodenal diverticula (PAD) are frequently asymptomatic but in rare cases can cause diverticulitis, diverticular bleed, obstructive jaundice, cholangitis, acute pancreatitis or recurrent acute pancreatitis. We present a case of periampullary diverticulitis with common bile duct (CBD) stricture. CASE DESCRIPTION/METHODS: A 45-year-old woman with no past history presented with nausea, vomiting and post-prandial upper abdominal pain. Her physical exam was significant for right upper quadrant tenderness. Initial labs showed WBC 15.6 k/mm3, lipase 436 U/L, AST 64 U/L, ALT 246 U/L, alkaline phosphatase 244 U/L and total bilirubin 2.8 mg/dL. Imaging of the abdomen revealed a dilated biliary tree of 1.2 cm, duodenal wall thickening and adjacent fat stranding. She was started on antibiotics. Endoscopic retrograde cholangiopancreatography (ERCP) showed periampullary duodenal diverticulitis with large amounts of pus extruding adjacent to the ampulla. Cholangiogram revealed distal CBD stricture, and dilated common, left and right hepatic ducts. Biliary sphincterotomy was performed, the stricture was brushed and a plastic CBD stent was placed. Her symptoms resolved and her abnormal lab parameters resolved. Cytology from the brushing was negative for malignancy. Magnetic resonance imaging was done and showed normal pancreas. Repeat ERCP seven months later revealed a persistent stricture spanning the distal half of the CBD - brushings were obtained and a stent was placed. Repeat brushings were negative for malignancy, her tumor markers were within normal limits and the patient is waiting for hepatobiliary surgery intervention for the stricture. DISCUSSION: PADs are frequently found during endoscopic evaluation and studies suggest a prevalence of up to 23%. PAD can be a hindrance to cannulation with reported cannulation rates of 61-95% and complications of ERCP did not differ between patients with and without PAD. Our case highlights the importance of recognizing duodenal diverticulitis in the differential diagnosis of cholangitis. In most cases of diverticulitis, antibiotics and sphincterotomy are sufficient to relieve the obstruction and treat the infection. The case presented highlights a persistent stricture as a consequence of extensive scarring from periampullary duodenal diverticulitis. Despite initial management with antibiotics, sphincterotomy and stent placement, some cases require surgical intervention.Figure 1.: Cholangiogram showing stricture spanning the distal half of the CBD.Figure 2.: ERCP showing periampullary duodenal diverticulitis.

Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis.

Dominant pancreatic duct strictures in chronic pancreatitis are often managed by endoscopic placement of a single plastic stent. Insertion of multiple plastic stents (MPS) has been proven to be effective in managing refractory strictures, but data are still limited. The aim of this study was to investigate the efficacy and long-term results of MPS to dilate pancreatic duct strictures in chronic pancreatitis. 48 patients (34 men; mean age 44 years) with chronic pancreatitis and a single pancreatic stent through a refractory stricture in the pancreatic head underwent the following protocol: 1)removal of the single pancreatic stent; 2)balloon dilation of the stricture; 3)insertion of the maximum number of stents; 4)stent removal after 6 - 12 months. The median number of pancreatic plastic stents placed was 3 (diameter 7 - 11.5 Fr, length 3 - 7 cm). Five patients (10.4 %) had persistent strictures after MPS removal. During a mean follow-up of 9.5 years (0.3 - 15.5 years) after stent removal, 74.4 % (32/43) of the patients were asymptomatic, and 25.6 % (11/43) experienced pancreatitis recurrence or pancreatic type pain after a mean time of 26.4 months (8/43, 18.6 % underwent plug extraction without evidence of stricture recurrence; 3/43, 7.0 % had stricture recurrence). No major complications were recorded. Endoscopic multiple plastic stenting of chronic pancreatitis-related pancreatic duct strictures showed satisfactory long-term results, with the option of re-treatment. This procedure can be considered an important therapeutic alternative for painful pancreatic duct strictures located in the head of the pancreas in the setting of chronic pancreatitis.

Tubercular Intestinal Strictures Show a Poor Response to Anti-Tuberculous Therapy.

The literature on resolution of intestinal strictures in patients with intestinal tuberculosis (ITB) after anti-tuberculous therapy (ATT) is sparse and ambivalent. We aimed to assess the frequency of stricture resolution after ATT and its predictors. This ambispective cohort study included consecutive ITB patients with strictures who received ATT for ≥6months and were on regular follow-up between January 2004 and December 2015. Resolution of stricture was assessed at the end of ATT by endoscopy/radiology. Of 286 patients, 128 had strictures, and 106 were finally included (63 males, median age 35years). The stricture location was distal ileum/ileocecal in 52 (49.1%), colon in 37 (34.9%), ileocolonic in 4 (3.8%), proximal small bowel in 10 (9.4%), and gastroduodenal in 4 (3.8%) patients. Although all patients demonstrated mucosal healing (indicating resolution of active infection), stricture resolution occurred only in 25/106 (23.6%) patients. Symptoms pertaining to stricture (pain abdomen/recurrent SAIO) were present in 104/106 (98%) patients, and after a median of 6 (6-9) months of ATT, these symptoms resolved only in half, 88% (22/25) in patients with stricture resolution and 38% (30/79) in patients with persistent strictures. Colonic strictures had the least resolution (5.4%) followed by proximal small intestinal (20%) and distal ileal/ileocecal (36.5%). Although not statistically significant, stricture resolution was less frequent in patients with multiple strictures, longer strictures (>3cm), and strictures in which scope was not negotiable prior to ATT. Only one-fourth of ITB patients with strictures show resolution of stricture following ATT. The resolution of strictures is dependent on disease location, and majority of them exhibit symptoms pertaining to stricture even after ATT.

Outcomes of Endoscopic Stenting for Traumatic Biliary and Pancreatic Fistulae

The role of endoscopic retrograde cholangiopancreatography (ERCP) in the trauma patient is limited. Therefore, reporting of outcomes is sparse in the literature. The purpose of this study was to review outcomes of patients who underwent ERCP for traumatic biliopancreatic injury. We retrospectively reviewed 1550 ERCPs, from a prospectively maintained database, performed by a single surgical endoscopist consulted by the trauma surgical service for the management of traumatic fistulae. Referral was made for patients with high output (greater than 200 mL/d) and/or persistent (failure to resolve within 30 days) fistulae and traumatic biliary stricture. Primary end point was postprocedural complications. Secondary end points included patient characteristics, stents placed, and duration of stenting. Seventeen patients underwent a total of 31 ERCPs for biliary and/or pancreatic injury resulting from abdominal trauma (eight penetrating, nine blunt). Fourteen patients had ERCP after laparotomy, with a mean interval to ERCP of 74 days. In three patients, ERCP was the only intervention required. Fourteen biliary stents were placed, seven of which were metallic. Ten pancreatic stents were placed; one proximally migrated but was successfully retrieved. Four patients had both ducts simultaneously stented. The mean duration of stenting was 158 days. All fistulae resolved after stenting. There were no serious complications.

Novel Concept and Method of Endoscopic Urethral Stricture Treatment Using Liquid Buccal Mucosal Graft

We describe a novel method of urethral stricture treatment using liquid buccal mucosal grafts to augment direct vision internal urethrotomy. A rabbit stricture model was used to test this method. In phase 1 the concept of endoscopic liquid buccal mucosal graft implantation was tested by performing direct vision internal urethrotomy in 3 rabbits with immediate intraurethral injection of autologous liquid buccal mucosal grafts suspended in fibrin glue. Animals were sacrificed at 2 to 3 weeks and the urethras were examined for the presence of buccal mucosa engraftment. In phase 2 strictures were induced by electroresection in 9 rabbits divided into 2 groups, including 1) 6 rabbits treated with direct vision internal urethrotomy and liquid buccal mucosal grafts, and 2) 3 controls that underwent direct vision internal urethrotomy and injection of fibrin glue only. Two treated and 1 control animals were sacrificed at 8, 16 and 24 weeks each. Prior to sacrifice the animals underwent retrograde urethrograms and urethroscopy. Histological specimens were examined for the presence of buccal mucosal engraftment. In phase 1, 2 of the 3 rabbits demonstrated engraftment of buccal mucosa in the urethra after injection of liquid buccal mucosal grafts. In phase 2 all 6 treated animals demonstrated engraftment with resolution/improvement of strictures on retrograde urethrograms and urethroscopy. Controls had no buccal engraftment and showed fibrosis and chronic inflammation. One of the 3 controls had persistent stricture on retrograde urethrograms and cystoscopy. This proof of concept study demonstrated the feasibility of using liquid buccal mucosal grafts for endoscopic urethral stricture repair. Such a method may allow for wide application of this novel concept of using liquid buccal mucosal grafts to augment direct vision internal urethrotomy.

Placement of a novel fully covered metallic stent for refractory pancreatic duct stricture

Plastic stent placement under endoscopic retrograde cholangiopancreatography is performed widely for the treatment of benign pancreatic stricture [1]. However, this techniquemay have several disadvantages such as short stent patency and persistent stricture compared with fully covered metallic stents (FCMS) [2,3]. Therefore, although FCMS placement for benign pancreatic stricture is still controversial as a result of a relatively high rate of stent migration (especially distal migration), the FCMS has a potential clinical impact in patients with symptomatic chronic pancreatitis. This report describes the placement of a novel FCMS (6mm×6cm, Niti-S Biliary S-Type Stent Long Suture; TaeWoong Medical, Seoul, Korea; Century Medical Inc., Tokyo, Japan) in patients with chronic pancreatitiswho have refractory pancreatic duct stricture (● Fig.1). This novel FCMShas a long removal suture, and therefore, if distal stent migration doesoccur, the stent can be removedeasily by grasping the suture thread. A 66-year-old man was admitted to the Osaka Medical College Hospital with abdominal pain caused by pancreatic stent occlusion. He had undergone placement of a 10-Fr plastic stent 1 month earlier for pancreatic duct stricture caused by chronic pancreatitis. Despite several stent exchanges, the pancreatic duct stricture persisted. Therefore, it was decided to place a novel FCMS. First, the plastic stent was removed, and contrast medium was injected into the main pancreatic duct. A pancreatic duct stricture of the pancreatic head was seen (● Fig.2). Next, the novel metallic stent delivery system (8Fr) was inserted through the stenosis site (● Fig.3), and the stent was successfully placed (● Fig.4, ● Video 1). No adverse events occurred and the patient was discharged. After 6 months, no late adverse events, including stent migration, were observed. This stent may be a safer device because if the stent migrates it can be retrieved easily by grasping the long suture thread. However, results from a prospective study with long term follow-up are needed to confirm this.

Anorectal stricture in 102 patients with Crohn's disease: natural history in the era of biologics.

The natural history of nonfistulising perianal Crohn's disease (PCD) remains unknown. To assess the long-term outcome of anorectal strictures. All outcomes of PCD patients with anorectal stricture followed in a single unit from 2005 to 2013 were reviewed, as well as subsequent therapeutic management. Cumulative incidence of stricture healing (disappearance of the anal stricture) was estimated using a Kaplan-Meier method and factor associated with an unfavourable course (persistent stricture S2, persistent stoma or proctectomy) with nonparametric test. A total of 102 patients (M/F: 37/65) were included. The duration of CD at diagnosis was 8.9 years. After a median follow-up period of 2.8 years, 52 of the 88 followed patients (59%) achieved anorectal stricture healing. Two patients (2%) developed anal adenocarcinoma. Female gender [HR 2.05 (1.1-4.03), P = 0.0221], disease duration of CD of less than 10 years [HR 1.94 (1.01-3.63), P = 0.0271], and anal fistula at stricture diagnosis [HR 2.36 (1.21-5.05), P = 0.0106) were significantly associated with anorectal stricture healing in a multivariate analysis model. Twenty-eight patients (32%) had an unfavourable course at the end of follow-up. Gender and introduction or optimisation of TNFα antagonist treatment decreased the risk of unfavourable course in multivariate analysis. Conversely, the Luminal B2 phenotype at CD diagnosis was the only factor associated with unfavourable course. Anorectal stricture does not imply a nonreversible and complicated condition related to severe perianal Crohn's disease. However, both the diagnosis of cancer and sepsis drainage remain challenging in this situation.

Clinical Application of Mucosal Valve Technique for Anastomosis During Esophagogastrostomy

BackgroundThe study aims to compare the efficacy in prevention of anastomotic complications using layer-to-layer mucosal valve technique versus circular stapled technique for esophagogastric intrathoracic anastomosis after resection for esophageal and gastric cardiac carcinoma. MethodsFrom January 2005 to December 2010, 136 patients received layer-to-layer mucosal valve technique (LM group), 219 received circular stapled anastomosis (CS group) after curative intent resection for esophageal and gastric cardiac carcinoma. The technique details were reported and the clinical results were analyzed. ResultsThe two groups were comparable on clinical baseline characteristics. The average duration of operation was longer with LM technique by 16 min, but without statistical significance (P = 0.073). There was no anastomotic leakage in the LM group, while in the CS group, leakage occurred in seven patients (3.2 %, P = 0.047). Both the incidence and grade of postoperative dysphagia were significantly lower in the LM group (P < 0.05). Significantly fewer patients experienced stricture after LM technique (3.8 %) compared with CS anastomosis (18.2 %, P < 0.001). CS anastomosis was associated with a significantly higher incidence of persistent stricture requiring more dilatation (P < 0.001). Symptoms of reflux were better controlled by LM technique; 82.7 % of patients were asymptomatic with respect to reflux compared to 58.9 % in the CS group, P < 0.001. And there was a significant reduction in the incidence of esophagitis in remnant esophagus in the LM group (P = 0.001). ConclusionsThe layered mucosal valve anastomosis could significantly diminish the incidence of anastomotic complications and could be used as an alternative for esophagogastric anastomosis after resection of esophageal and gastric cardiac carcinoma.

Do Steroid Injections Work for Esophagogastric Anastomotic Strictures

The clinical management of benign persistent anastomotic strictures of the esophagus is often challenging. Corticosteroid injection coupled with dilation has been shown to be effective in refractory peptic strictures, but does it work for anastomotic strictures? In a multicenter, double-blind trial, 60 patients with solid-food dysphagia and an untreated cervical esophagogastric anastomotic stricture after esophagectomy were randomized to receive triamcinolone or saline injection. For mild strictures, dilation to 16 mm was …

Biliary Web: Diagnosis With High-Definition Videocholangioscopy

A74-year-old obese woman presented to our center for evaluation of a persistent biliary stricture requiring intermittent stenting of the bile duct. A detailed history showed that she had undergone 15 to 20 endoscopic retrograde cholangiopancreatography (ERCP) examinations within the past 10 years for this problem. During most of these examinations, bile duct stones proximal to the stricture were found and removed. Brushings of the stricture had been negative for malignancy. Her last ERCP, 3 weeks before referral, again showed the presence of a stricture just proximal to the insertion of the cystic duct. At our center, she underwent an ERCP with peroral cholangioscopy. The ERCP confirmed the presence of the stricture. High-definition peroral videocholangioscopy (CHF-Y0002B; Olympus Corporation, Tokyo, Japan) showed a biliary web just proximal to the insertion of the cystic duct at the site of the presumed stricture (Figures A and B). Biliary webs are rare, with approximately 20 cases reported in the literature. The majority of biliary webs are associated with choledocholithiasis as a result of impaired biliary drainage. Although the exact mechanism behind formation of webs in the bile ducts is not known, at least some are believed to be congenital. During the development of the human embryo, the bile ducts pass through a solid stage, becoming obliterated by epithelial proliferation. Recanalization of the lumen of the biliary tree usually starts at the end of the fifth week of gestation. Incomplete recanalization could lead to web development. The diagnosis of biliary webs typically is made by contrast cholangiography or magnetic resonance imaging. Although radiographic images of biliary webs have been reported previously, direct in vivo cholangioscopic image of a biliary web has not been published. The patient was referred to surgery and underwent a successful choledochoduodenostomy. Pathology of the web showed fibrosis and chronic inflammation, which likely was caused by mechanical irritation by stones (Figure C). The patient has had more than a year of follow-up evaluation without any biliary problems.

867 Pre-Transplant Factors Influencing Listing for Simultaneous Liver-Kidney Transplantation

in 6 patients; 2 patients suffered bile leaks; and 1 patient had both. The mean indwelling duration was 12.4 weeks (range 7.3-18.6). After stent removal, 8 of 9 patients experienced the resolution of their biliary complications. For these 8 patients, themean pre-fcSEMS alanine aminotransferase/alkaline phosphatase/bilirubin were 98.4/220/4.6, versus 54.5/123.1/1.6 at the time of stent retrieval and 52.8/116.6/1.0 six months later. The positive outcomes persevered for at least 6 months after fcSEMS retrieval. The lone exception had a persistent anastomotic stricture despite fcSEMS, and was subsequently treated with side-by-side plastic stents. The chief stent-related complications were stent migration (4/9) and post-ERCP pancreatitis (2/9). Only in 1 case was stent migration significant enough to have resulted in a complete dislodgement of the prosthesis from the biliary tract. Conclusion: For liver transplant recipients with biliary complications, the fcSEMS seems to be a safe and effective treatment option with a potential for reducing the overall number of ERCPs needed. Future cost analyses can help establish whether fcSEMS should be first-line therapy or reserved only for patients who fail to improve with the conventional progressive plastic stenting practices.

Palliative radiotherapy in esophageal cancer.

The present study was undertaken to evaluate the efficacy of radiotherapy in palliation of dysphagia in patients with squamous cell carcinoma (SCC) of esophagus and to see the quality of life (QoL) following radiotherapy. This was a prospective clinical study done between September 2006 and May 2008. All consecutive patients with SCC of the esophagus, who are not candidates for definitive treatment, were included in the study. Dysphagia and QoL were assessed using modified Takita's grading and modified questionnaire based on EORTC QLQ 30 respectively. External beam radiotherapy (EBRT) was delivered to all patients using linear accelerator 6 Mv photons. Patients who had good response with EBRT were further subjected to intraluminal brachytherapy (ILBT) at 700cGy using Iridium-192. The cumulative dose each patient received was 65Gy. Patients were followed up at 6weeks from completion of treatment to look for any difference in dysphagia grade and QoL following therapy. Thirty-three patients were included in the study. The mean age among males and females was 60.9 and 49.8years, respectively. Nineteen patients (57.6%) received EBRT followed by ILBT; the remaining patients received only EBRT. Seven were lost during follow-up, and seven (21.2%) died during the study period of 6weeks. Nineteen (57.6%) were followed up. On follow-up endoscopy, evidence of residual stricture was observed in 57.9%, and growth in 36.8%. Of the patients, 27.8% had biopsy-confirmed residual disease. The median dysphagia score decreased from 4 to 3 after treatment (p = 0.002) in 17 (89.5%) patients. The mean QoL score improved from 107.5 to 114.1 at 6-week follow-up. Following radiotherapy, 26.3% had persistent chest pain, increased cough with expectoration in 15.8%, and hyperpigmentation of skin in 10.5%. Radiotherapy gives significant relief of dysphagia and improves QoL in 90% of patients with SCC of esophagus. However, following radiotherapy, a number of patients will have persistent stricture, ulceration, and residual disease.

WEO NEWSLETTER AND CONTENTS

WEO NEWSLETTER AND CONTENTS

TEMPORARY USE OF A NEW FULLY-COVERED SELF-EXPANDING METAL STENT FOR THE MANAGEMENT OF POST-ESOPHAGECTOMY STRICTURES

Perioperative morbidity rates following esophagectomy for esophageal cancer remain quite high (26-41%) even at high-volume centers. Complications may include stricture at the esophagogastric (EG) anastomosis, as well as tracheo-esophageal or tracheo-gastric fistula formation. Fully-covered self-expanding metal stents (FCSEMS) have only recently been described for use in benign esophageal disease. The use of FCSEMS for the management of postoperative complications following esophagectomy has not been well studied. We report our observations in three consecutive patients that underwent placement and subsequent removal of a new, fully-covered metal stent (Wallflex esophageal stent) for treatment of dysphagia due to a persistent stricture at the EG anastomosis.

An end-to-end anastomosis model of guinea pig bile duct: A 6-mo observation

To establish the end-to-end anastomosis (EEA) model of guinea pig bile duct and evaluate the healing process of bile duct. Thirty-two male guinea pigs were randomly divided into control group, 2-, 3-, and 6-mo groups after establishment of EEA model. Histological, immunohistochemical and serologic tests as well as measurement of bile contents were performed. The bile duct diameter and the diameter ratio (DR) were measured to assess the formation of relative stricture. Acute and chronic inflammatory reactions occurred throughout the healing process of bile duct. Serology test and bile content measurement showed no formation of persistent stricture in 6-mo group. The DR revealed a transient formation of relative stricture in 2-mo group in comparation to control group (2.94 ± 0.17 vs 1.89 ± 0.27, P = 0.004). However, this relative stricture was released in 6-mo group (2.14 ± 0.18, P = 0.440). A simple and reliable EEA model of guinea pig bile duct can be established with a good reproducibility and a satisfactory survival rate.

Treatment of long ureteric strictures with buccal mucosal grafts

To describe the reconstruction of long ureteric strictures using buccal mucosal patch grafts and to report the intermediate-term functional outcome. Between November 2000 and October 2006 reconstruction of seven long ureteric strictures using buccal mucosal patch grafts and omental wrapping was performed in five women (one with bilateral strictures) and one man. The surgical steps of stricture reconstruction and wrapping with omentum are described in detail. Stricture recurrence was defined as persistent impaired ureteric drainage as displayed by imaging techniques or the necessity to prolong JJ stenting. Patency rates and stricture recurrence-free survival rates are provided. With a median follow up of 18 months five of the seven strictures were recurrence-free. Graft take was good in all patients. In one asymptomatic patient, there was impaired ureteric drainage on the reconstructed side, and in one patient with reconstruction of both ureters prolonged JJ stenting of one side was necessary. In both patients, the impaired drainage was caused by persistent stricture below the reconstructed ureteric segments. At intermediate-term follow-up in a small group of patients with long ureteric strictures, treatment with buccal mucosal patch grafts and omental wrapping showed good functional outcome.