Choledochoscopic high-frequency needle-knife electrotomy for treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy

Abstract

BackgroundAnastomotic stricture is a complex and substantial complication following Roux-en-Y hepaticojejunostomy. Initially, endoscopic and percutaneous approaches are often attempted, but the gold standard remains surgical biliary reconstruction, especially for refractory stricture. However, this solution leaves much room for improvement, due to the challenging nature of the biliary reconstruction procedure, in which anastomotic stricture may still occur.AimsTo investigate the feasibility and effectiveness of choledochoscopic high-frequency needle-knife electrotomy as an intervention in the treatment of anastomotic strictures following Roux-en-Y hepaticojejunostomy.MethodsFrom February 2010 to October 2014, clinical data was collected and retrospectively compared for patients who underwent balloon dilation or/and choledochoscopic high-frequency needle-knife electrotomy for the treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy.ResultsA total of 38 patients underwent successful choledochoscopic treatment and all the anastomotic strictures were removed successfully, 19 of which were treated with electrotomy, 7 with balloon dilation, and 12 with both electrotomy and balloon dilation. Among these groups,the average operating times were 6.9 ± 2.4 min,10.1 ± 6.8 min, and 20.2 ± 13.5 min, respectively. The average stent supporting times were 6.3 ± 0.7 months, 6.5 ± 0.6 months, and 6.1 ± 0.4 respectively. The mean follow-up after stent removal was 42.1 ± 27.4 months, and in 26.3 % (5/19), 28.5 % (2/7) and 16.7 % (2/12) of cases, recurrent anastomotic stricture occurred. Of these 9 total patients with recurrent anastomotic, two patients were successfully rescued by full-covered self-expanding removable metal stents and 7 patients by electrotomy combined with balloon dilation.ConclusionsCholedochoscopic high-frequency needle-knife electrotomy is both feasible and safe in the treatment of anastomotic stricture after Roux-en-Y hepaticojejunostomy, with a similar long-term outcome to balloon dilation in treating anastomotic stricture after Roux-en-Y hepaticojejunostomy. A combination of choledochoscopic electrotomy concurrent with balloon dilation should be recommended based on the low rate of recurrence.

Jaundice caused by protrusion of a hepatic cyst into common bile duct that was resolved by choledochoscopic needle-knife electrotomy: a case report

“…This is a new technology that was developed from endoscopic sphincterotomy. We have previously reported this new procedure as a potential complementary medical approach for treating intrahepatic biliary stricture associated with hepatolithiasis and anastomotic strictures after Roux-en-Y hepaticojejunostomy [ 22 , 23 ]. Choledochoscopic high-frequency needle-knife electrotomy has the effect of cutting and solidification, which can achieve the purpose of separation of tissue and hemostasis by the touch of needle-knife and tissue.…”

Step-by-step strategy in the management of residual hepatolithiasis using post-operative cholangioscopy

“… 49 The yellow Zebra guide wire (Boston Scientific, Boston, USA) is inserted into the strictured bile duct, guiding the insertion of the balloon dilatation catheter, to ensure the catheter occupies the length of the strictures. 50 Bougie dilatation is indicated as an efficient method to treat strictures. 51 Wire-guided needle-knife electro-incision appears to be effective for traversing refractory biliary or pancreatic strictures.…”