Eight patients with biliary obstruction and a pre-operative diagnosis of a neoplastic lesion at the confluence of the hepatic ducts were found postoperatively to have benign disease. Cholangiography was highly suggestive of a malignant stricture in all patients. Angiography performed in six patients indicated that the lesions were potentially resectable. Seven patients underwent elective surgery; in six the ductal confluence including the lesion was removed, without mortality. Six patients are alive, five of them totally asymptomatic, in a median follow-up of 32 months. Many patients with hilar strictures are treated for what appears radiologically to be a neoplastic lesion. Since treatment often involves the placement of an endoprosthesis or palliative surgery, without histological diagnosis, some of these patients with benign disease are likely to be treated inappropriately, unless they are considered for a curative resection.

Percutaneous transjejunal biliary access allows repeated interventions over many years with a low morbidity. Routine superficial fixation of Roux-en-Y loops is recommended for all biliary-enteric anastomoses to allow use of this safe and effective approach for any subsequent biliary intervention.

Objective To assess outcomes of percutaneous transjejunal biliary intervention (PTJBI) in terms of success and effectiveness in patients with a Roux-en-Y hepaticojejunostomy for benign biliary strictures and stones. Methods Clinical and radiographic records of 63 patients with a Roux-en-Y choledochojejunostomy or hepaticojejunostomy for benign disease who underwent at least one PTJBI between 1986 and 2007 were reviewed. Effectiveness was determined by successful access rate, rates of stricture dilatation and/or stone extraction, morbidity, complications and hospitalisation. Results PTJBI was attempted 494 times. Successful access to the Roux-en-Y was accomplished in 93% of interventions. After access to the Roux-en-Y was granted, all strictures were effectively dilated. Ninety-seven percent of extraction attempts of intrahepatic calculi were successful. The median number of interventions per patient was five. The median interval between interventions was 51.5 weeks (range 2.7-1,279.6 weeks). The early complication rate was 3%. Morbidity, measured in terms of cholangitis episodes was 14%, in 25 out of 63 patients. Mean hospitalisation was 4.1 nights per year. Conclusion PTJBI is safe and effective in treating benign biliary strictures and/or calculi. High success rates and short hospitalisation periods, together with few complications make it a well-accepted and integral part of managing complex biliary problems.

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