Outcomes of patients with hepaticojejunostomy anastomotic strictures undergoing endoscopic and percutaneous treatment

Abstract

Background and study aims The increase in hepaticojejunostomies has led to an increase in benign strictures of the anastomosis. Double balloon enteroscopy-assisted ERCP (DBE-ERCP) and percutaneous transhepatic biliary drainage (PTBD) are treatment options; however, there is lack of long-term outcomes, with no consensus on management. We performed a retrospective study assessing the outcomes of patients referred for endoscopic management of hepaticojejunostomy anastomotic strictures (HJAS).

Patients and methods All consecutive patients at a tertiary institution underwent endoscopic intervention for suspected HJAS between 2009 and 2021 were enrolled.

Results Eighty-two subjects underwent DBE-ERCP for suspected HJAS. The technical success rate was 77 % (63/82). HJAS was confirmed in 41 patients. The clinical success rate for DBE-ERCP ± PTBD was 71 % (29/41). DBE-ERCP alone achieved clinical success in 49 % of patients (20/41). PTBD was required in 49 % (20/41). Dual therapy was required in 22 % (9/41). Those with liver transplant had less technical success compared to other surgeries (72.1 % vs 82.1 % P = 0.29), less clinical success with DBE-ERCP alone (40 % vs 62.5 % P = 0.16) and required more PTBD (56 % vs 37.5 % P = 0.25). All those with ischemic biliopathy (n = 9) required PTBD for clinical success, required more DBE-ERCP (4.4 vs 2.0, P = 0.004), more PTBD (4.7 vs 0.3, P < 0.0001), longer treatment duration (181.6 vs 99.5 days P = 0.12), and had higher rates of recurrence (55.6 % vs 30.3 % P = 0.18) compared to those with HJAS alone. Liver transplant was the leading cause of ischemic biliopathy (89 %). The overall adverse event rate was 7 %.

Conclusions DBE-ERCP is an effective diagnostic and therapeutic tool in those with altered gastrointestinal anatomy and is associated with low complication rates.

Publikationsverlauf

Eingereicht: 07. Juni 2022

Angenommen nach Revision: 20. September 2022

Accepted Manuscript online:
28. September 2022

Artikel online veröffentlicht:
04. Januar 2023

• References

• 1 Reid-Lombardo KM, Ramos-De La Medina A, Thomsen K. et al. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg 2007; 11: 1704-1711
• 2 House MG, Cameron JL, Schulick RD. et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243: 576-578
• 3 Morita S, Kitanosono T, Lee D. et al. Comparison of technical success and complications of percutaneous transhepatic cholangiography and biliary drainage between patients with and without transplanted liver. AJR Am J Roentgenol 2012; 199: 1149-1152
• 4 Lee AY, Gregorius J, Kerlan RK. et al. Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries. PLoS One 2012; 7: e46478
• 5 Mukund A, Rajesh S, Agrawal N. et al. Percutaneous management of resistant biliary-enteric anastomotic strictures with the use of a combined cutting and conventional balloon cholangioplasty protocol: A single-center experience. J Vasc Interv Radiol 2015; 26: 560-565
• 6 Bonnel DH, Fingerhut AL. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: Long-Term results in 110 patients. Am J Surg 2012; 203: 675-683
• 7 Fontein DBY, Gibson RN, Collier NA. 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: 557-565
• 8 Liu K, Joshi V, Saxena P. et al. Predictors of success for double balloon-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anastomosis. Dig Endosc 2017; 29: 190-197
• 9 Tee HP, How SH, Kaffes AJ. Learning curve for double-balloon enteroscopy: Findings from an analysis of 282 procedures. World J Gastrointest Endosc 2012; 4: 368-372
• 10 Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 2002; 56: 225-232
• 11 Chua TJ, Kaffes AJ. Tu1594 The utility of balloon assisted enteroscopy in post liver transplant patients with surgically altered anatomy: a single center experience. Gastrointest Endosc 2011; 73: 887-891
• 12 Mizukawa S, Tsutsumi K, Kato H. et al. Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple’s procedure: A retrospective study. BMC Gastroenterol 2018; 18: 14
• 13 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 2020; 34: 1612-1620
• 14 Tomoda T, Tsutsumi K, Kato H. et al. Outcomes of management for biliary stricture after living donor liver transplantation with hepaticojejunostomy using short-type double-balloon enteroscopy. Surg Endosc 2016; 30: 5338-5344
• 15 Tomoda T, Kato H, Miyamoto K. et al. Comparison between endoscopic biliary stenting combined with balloon dilation and balloon dilation alone for the treatment of benign hepaticojejunostomy anastomotic stricture. J Gastrointest Surg 2020; 24: 1352-1358
• 16 Hammad H, Brauer BC, Smolkin M. et al. Treating biliary-enteric anastomotic strictures with enteroscopy-ercp requires fewer procedures than percutaneous transhepatic biliary drains. Dig Dis Sci 2019; 64: 2638-2644
• 17 Sato T, Kogure H, Nakai Y. et al. Endoscopic treatment of hepaticojejunostomy anastomotic strictures using fully-covered metal stents. Dig Endosc 2021; 33: 451-457
• 18 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 19 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
• 20 Kaffes AJ. Management of benign biliary strictures: current status and perspective. J Hepatobiliary Pancreat Sci 2015; 22: 657-663
• 21 Zajko AB, Bron KM, Campbell WL. et al. Percutaneous transhepatic cholangiography and biliary drainage after liver transplantation: A five-year experience. Gastrointest Radiol 1987; 12: 137-143
• 22 Kühn JP, Busemann A, Lerch MM. et al. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. AJR Am J Roentgenol 2010; 195: 851-857
• 23 Rees J, Mytton J, Evison F. et al. The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: A retrospective cohort study. BMJ Open 2020; 10: e033576
• 24 Matsunaga Y, Higuchi R, Yazawa T. et al. Correction to: Negative prognostic outcomes of percutaneous transhepatic biliary drainage in distal cholangiocarcinoma: a retrospective analysis using propensity score matching. Int J Clin Oncol 2021; 26: 1775
• 25 Shao XD, Qi XS, Guo XZ. Endoscopic retrograde cholangiopancreatography with double balloon enteroscope in patients with altered gastrointestinal anatomy: A meta-analysis. Saudi J Gastroenterol 2017; 23: 150-160
• 26 Weber A, Rosca B, Neu B. et al. Long-term follow-up of percutaneous transhepaticbiliary drainage (PTBD) in patients with benign bilioenterostomy stricture. Endoscopy 2009; 41: 323-328
• 27 Tapping CR, Byass OR, Cast JEI. Percutaneous transhepatic biliary drainage (PTBD) with or without stenting-complications, re-stent rate and a new risk stratification score. Eur Radiol 2011; 21: 1948-1955
• 28 Azeemuddin M, Turab N, Chaudhry MBH. et al. Percutaneous management of biliary enteric anastomotic strictures: an institutional review. Cureus 2018; 10: e2228
• 29 Delden OM, Laméris JS. Percutaneous drainage and stenting for palliation of malignant bile duct obstruction. Eur Radiol 2008; 18: 448-456
• 30 Kakked G, Salameh H, Cheesman A. et al. Primary EUS-guided biliary drainage versus ERCP drainage for the management of malignant biliary obstruction: A systematic review and meta-analysis. Endosc Ultrasound 2020; 9: 298-307
• 31 Khashab M, el Zein M, Sharzehi K. et al. EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study. Endosc Int Open 2016; 4: E1322-E1327