Endoscopic Balloon Dilation for Benign Bilioenteric Stricture: Outcomes and Factors Affecting Recurrence.
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
Bile Duct Diseases
Bile Ducts, Intrahepatic
/ surgery
Cholangiopancreatography, Endoscopic Retrograde
/ methods
Cholestasis
/ surgery
Cholestasis, Intrahepatic
/ surgery
Constriction, Pathologic
Dilatation
/ methods
Female
Humans
Jejunum
/ surgery
Male
Middle Aged
Postoperative Complications
/ surgery
Balloon enteroscopy
Bilioenteric stricture
Endoscopic balloon dilation
Surgically altered anatomy
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
23
01
2019
accepted:
20
08
2019
pubmed:
29
8
2019
medline:
23
6
2020
entrez:
29
8
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 31456093
doi: 10.1007/s10620-019-05811-3
pii: 10.1007/s10620-019-05811-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3557-3567Commentaires et corrections
Type : CommentIn
Références
Murr MM, Gigot JF, Nagorney DM, Harmsen WS, Ilstrup DM, Farnell MB. Long-term results of biliary reconstruction after laparoscopic bile duct injuries. Arch Surg. 1999;134:604–609 (discussion 609–10).
doi: 10.1001/archsurg.134.6.604
House MG, Cameron JL, Schulick RD, et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg. 2006;243:571–576 (discussion 576–8).
doi: 10.1097/01.sla.0000216285.07069.fc
Reid-Lombardo KM, Ramos De-la Medina A, Thomsen K, Harmsen WS, Farnell MB. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg. 2007;11:1704–1711.
doi: 10.1007/s11605-007-0369-7
Davids PH, Tanka AK, Rauws EA, et al. Benign biliary strictures. Surgery or endoscopy? Ann Surg. 1993;217:237–243.
doi: 10.1097/00000658-199303000-00004
Vitale GC, Tran TC, Davis BR, et al. Endoscopic management of postcholecystectomy bile duct strictures. J Am Coll Surg. 2008;206:918–923 (discussion 924–5).
doi: 10.1016/j.jamcollsurg.2008.01.064
Schumacher B, Othman T, Jansen M, Preiss C, Neuhaus H. Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy. 2001;33:409–415.
doi: 10.1055/s-2001-14264
Weber A, Rosca B, Neu B, et al. Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) in patients with benign bilioenterostomy stricture. Endoscopy. 2009;41:323–328.
doi: 10.1055/s-0029-1214507
Kucukay F, Okten RS, Yurdakul M, et al. Long-term results of percutaneous biliary balloon dilation treatment for benign hepaticojejunostomy strictures: Are repeated balloon dilations necessary? J Vasc Interv Radiol. 2012;23:1347–1355.
doi: 10.1016/j.jvir.2012.07.004
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.
doi: 10.1016/j.amjsurg.2012.02.001
Lee AY, Gregorius J, Kerlan RK Jr, Gordon RL, Fidelman N. Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries. PLoS ONE. 2012;7:e46478.
doi: 10.1371/journal.pone.0046478
Yamauchi H, Kida M, Okuwaki K, et al. Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy. World J Gastroenterol. 2013;19:1728–1735.
doi: 10.3748/wjg.v19.i11.1728
Yamauchi H, Kida M, Imaizumi H, et al. Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy. World J Gastroenterol. 2015;21:6460–6469.
doi: 10.3748/wjg.v21.i21.6460
Shimatani M, Hatanaka H, Kogure H, et al. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy: a multicenter prospective study in Japan. Am J Gastroenterol. 2016;111:1750–1758.
doi: 10.1038/ajg.2016.420
Sakakihara I, Kato H, Muro S, et al. Double-balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato-biliary-pancreatic operation. Dig Endosc. 2015;27:146–154.
doi: 10.1111/den.12332
Yamauchi H, Kida M, Okuwaki K, et al. Therapeutic peroral direct cholangioscopy using a single balloon enteroscope in patients with Roux-en-Y anastomosis (with videos). Surg Endosc. 2018;32:498–506.
doi: 10.1007/s00464-017-5742-3
Miyata E, Yamauchi H, Kida M, et al. Successful endoscopic dilation of severe bilioenteric strictures with a wire-guided diathermic dilator and short-type single-balloon enteroscope. Endoscopy. 2015;47:E94–E95.
doi: 10.1055/s-0034-1391240
Tsutsumi K, Kato H, Sakakihara I, et al. Dilation of a severe bilioenteric or pancreatoenteric anastomotic stricture using a Soehendra Stent Retriever. World J Gastrointest Endosc. 2013;5:412–416.
doi: 10.4253/wjge.v5.i8.412
Matthews JB, Baer HU, Schweizer WP, Gertsch P, Carrel T, Blumgart LH. Recurrent cholangitis with and without anastomotic stricture after biliary-enteric bypass. Arch Surg. 1993;128:269–272.
doi: 10.1001/archsurg.1993.01420150023004
Röthlin MA, Löpfe M, Schlumpf R, Largiadèr F. Long-term results of hepaticojejunostomy for benign lesions of the bile ducts. Am J Surg. 1998;175:22–26.
doi: 10.1016/S0002-9610(97)00229-8
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.
doi: 10.1016/j.gie.2009.10.027
Ran X, Yin B, Ma B. Four major factors contributing to intrahepatic stones. Gastroenterol Res Pract. 2017;2017:7213043.
doi: 10.1155/2017/7213043
Zhang R, Luo H, Pan Y, et al. Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination. Gastrointest Endosc. 2015;82:660–665.
doi: 10.1016/j.gie.2015.03.1908
Lai KH, Lo GH, Lin CK, et al. Do patients with recurrent choledocholithiasis after endoscopic sphincterotomy benefit from regular follow-up? Gastrointest Endosc. 2002;55:523–526.
doi: 10.1067/mge.2002.122611
Ammori BJ, Joseph S, Attia M, Lodge JP. Biliary strictures complicating pancreaticoduodenectomy. Int J Pancreatol. 2000;28:15–21 (discussion 21–2).
doi: 10.1385/IJGC:28:1:15
Cho KJ. Biliary stricture dilation: Are the unknowns known? J Vasc Interv Radiol. 2012;23:1355–1357.
doi: 10.1016/j.jvir.2012.07.027
Kobayashi T, Aoki T, Ikeda K, Kurokawa E. Hepatobiliary and pancreatic: unusual case of radiation-induced biliary stricture. J Gastroenterol Hepatol. 2017;32:1794.
doi: 10.1111/jgh.13919
Shibuya H, Hara K, Mizuno N, et al. Treatment of biliary strictures with fully covered self-expandable metal stents after pancreaticoduodenectomy. Endoscopy. 2017;49:75–79.
doi: 10.1055/s-0042-124498
Yamauchi H, Tadehara M, Kida M. Temporary non-flared fully covered self-expandable metal stent placement for refractory benign choledochojejunal anastomotic stricture. Dig Endosc. 2018;30:541–542.
doi: 10.1111/den.13069