Comparison Between Endoscopic Biliary Stenting Combined with Balloon Dilation and Balloon Dilation Alone for the Treatment of Benign Hepaticojejunostomy Anastomotic Stricture

Tomoda, Takeshi; Kato, Hironari; Miyamoto, Kazuya; Saragai, Yosuke; Mizukawa, Sho; Yabe, Shuntaro; Takata, Saimon; Muro, Shinichiro; Uchida, Daisuke; Matsumoto, Kazuyuki; Horiguchi, Shigeru; Tsutsumi, Keisuke; Hirao, Ken; Ogawa, Tsuneyoshi

doi:10.1007/s11605-019-04297-8

Cited by 28 publications

(39 citation statements)

References 15 publications

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“…We read with great interest the article by Tomoda et al about the evaluation of the outcomes of endoscopic treatment for benign hepaticojejunostomy anastomotic stricture. 1 We confirmed the importance of stent deployment in the treatment of this adverse event, in line with the available literature. 2,3 We would like to briefly focus on the main reason for this consideration.…”

Section: Dear Editorsupporting

confidence: 88%

Letter to Editor on “Comparison Between Endoscopic Biliary Stenting Combined with Balloon Dilation and Balloon Dilation Alone for the Treatment of Benign Hepaticojejunostomy Anastomotic Stricture”

Mutignani

Dioscoridi

Pugliese

et al. 2020

Journal of Gastrointestinal Surgery

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Section: Dear Editorsupporting

confidence: 88%

Letter to Editor on “Comparison Between Endoscopic Biliary Stenting Combined with Balloon Dilation and Balloon Dilation Alone for the Treatment of Benign Hepaticojejunostomy Anastomotic Stricture”

Mutignani

Dioscoridi

Pugliese

et al. 2020

Journal of Gastrointestinal Surgery

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“…Tomoda et al compared balloon dilation alone with endoscopic stenting for treating HJS under enteroscopic guidance in 103 and 34 patients, respectively [15]. In this study, multivariate analysis selected only balloon dilation as an independent risk factor (hazard ratio, 2.86; 95 % confidence interval, 1.44-6.55; P = 0.002).…”

Section: Discussionmentioning

confidence: 90%

Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video)

et al. 2020

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Background and study aims A novel fine-gauge electrocautery dilator (ED) has recently become available in Japan. The current study evaluated the safety and feasibility of transluminal antegrade dilation for hepaticojejunal stricture (HJS) using this novel ED. Patients and methods Patients who with complicated HJS were retrospectively enrolled. The primary and secondary endpoints of this study were rates of technical success defined as functional antegrade HJS dilation using the novel ED and types of adverse events, respectively. A total of 22 patients were enrolled. Among them, six were treated using an enteroscopic approach due to the absence of bile duct dilation or patient refusal to undergo EUS-HGS. Therefore, 16 patients underwent EUS-HGS. Results The procedure was successful in 15 of 16 patients (93.8 %). The contrast medium flowed from the intrahepatic bile duct to the intestine of 14 of 15 patients (93.3 %). The resolution rate of HJS was 13 of 14 (92.9 %) at 6 months. Conclusion Our technique might offer a new option with which to treat HJS, although a prospective study with long-term follow-up is needed.

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“…There were technical difficulties in the endoscopic management of HJASs until the emergence of balloon-assisted endoscopy allowed for an endoscopic approach to the hepaticojejunostomy anastomosis. Balloon dilation and plastic stent placement via DB-ERCP has been reported to be effective in retrospective studies; however, refractory HJAS was observed in about a quarter of patients owing to the limitation in the numbers and diameters of plastic stents deployed through a DBE [5,7]. To date, a few articles have reported FCSEMS placement for HJAS with the help of balloon-assisted endoscopy [29 -31]; however, in these reports, FCSEMSs were placed over the guidewire through the overtube left in situ while the endoscope itself was removed beforehand.…”

Section: Discussionmentioning

confidence: 99%

“…University Hospital Medical Network Clinical Trials Registry UMIN000022164 TRIAL REGISTRATION: Single-Center, Single-arm, prospective exploratory trial UMIN000022164 at http://www.umin.ac.jp Table 1s, Table 2s Online content viewable at: nical issues should be addressed because the stricture is located at the level of the hepatic duct or more peripheral intrahepatic duct. In these situations, endoscopic multiple stenting is technically difficult owing to the small diameter of the bile duct and bifurcation near to the stricture [6,7]. As a result, the rate of stricture resolution is not sufficiently high in these patients, and patients with refractory strictures require long durations of endoscopic, percutaneous, or even surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

A prospective study of fully covered metal stents for different types of refractory benign biliary strictures

et al. 2020

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Background While endoscopic management of benign biliary strictures (BBSs) is the standard of care, long-term treatment remains the issue in refractory cases, especially for anastomotic strictures after living-donor liver transplantation (LDLT) and hepaticojejunostomy anastomotic strictures (HJAS). The aim of this prospective study was to evaluate the safety and effectiveness of a fully covered self-expandable metal stent (FCSEMS) for patients with refractory BBSs. Methods Patients with BBSs that were unamenable to endoscopic plastic stent placement with a treatment period of more than 6 months were eligible. An FCSEMS was placed endoscopically and removed after 90 days. In patients with surgically altered anatomy, an FCSEMS was placed using a double-balloon endoscope. The primary outcome was stricture resolution at FCSEMS removal. The secondary outcomes included stricture recurrence and adverse events. Results A total of 30 patients were enrolled: the causes of their BBSs were anastomotic stricture after LDLT in 13, HJAS in 12, post-cholecystectomy in two, chronic pancreatitis in two, and post-hepatectomy in one. The technical success rate of FCSEMS placement was 100 % and all FCSEMSs were successfully removed. The rate of stricture resolution at FCSEMS removal was 96.6 % (91.7 % in the post-LDLT group and 100 % in the HJAS group). Stricture recurrence occurred in three HJAS patients (10.7 %) during a median follow-up period of 15.6 months. Adverse events were observed in 12.1 %: five cholangitis, one pancreatitis, and one perforation. Conclusion Temporary placement of an FCSEMS was a feasible and effective treatment option for refractory BBSs, especially for post-LDLT strictures and HJAS.

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Comparison Between Endoscopic Biliary Stenting Combined with Balloon Dilation and Balloon Dilation Alone for the Treatment of Benign Hepaticojejunostomy Anastomotic Stricture

Cited by 28 publications

References 15 publications

Letter to Editor on “Comparison Between Endoscopic Biliary Stenting Combined with Balloon Dilation and Balloon Dilation Alone for the Treatment of Benign Hepaticojejunostomy Anastomotic Stricture”

Letter to Editor on “Comparison Between Endoscopic Biliary Stenting Combined with Balloon Dilation and Balloon Dilation Alone for the Treatment of Benign Hepaticojejunostomy Anastomotic Stricture”

Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video)

A prospective study of fully covered metal stents for different types of refractory benign biliary strictures

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