Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

Abstract

Background/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.Methods: We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy–endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.Results: Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.Conclusions: Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

Impact of preoperative self‐expandable metal stent on benign hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy

“…Balloon dilation without stent placement may be permissible in cases without a residual balloon notch, as recurrent HJAS is less common in this population. 30 There are some limitations in this study. First, this is a retrospective study from a single institution.…”

“…Balloon dilation with or without the deployment of plastic stents or SEMSs has been reported to be useful for benign HJAS. 28 , 29 , 30 Despite the favorable outcomes with both plastic stents and SEMSs, one disadvantage is that additional procedures are required to remove stents. Balloon dilation without stent placement may be permissible in cases without a residual balloon notch, as recurrent HJAS is less common in this population.…”

“…Balloon dilation without stent placement may be permissible in cases without a residual balloon notch, as recurrent HJAS is less common in this population. 30 …”

Percutaneous transhepatic approach for the management of benign anastomotic stricture after hepaticojejunostomy: Balloon is enough?

“…However, whether early HJAS formation (< 1 year postoperatively to HJAS) is a risk factor for recurrent HJAS after balloon dilation alone remains unclear. 17,18 Another study by T. Mie et al, 19 they identified residual balloon notch on fluoroscopy as an independent predictor of recurrent HJAS. Balloon dilation alone may be sufficient if the notch disappears on fluoroscopy, with 1-year and 2-year patency rates of 82.1% and 73.1%, respectively.…”