Long-term results of oversized balloon dilation for benign anastomotic biliary strictures: initial two-center experience

Abstract Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication—a small dehiscence of the anastomosis—which extended the catheter dwell time. Minor complications occurred in two cases—one small perihepatic hematoma and one segmental thrombosis of the left portal branch—neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.

Resumo Objetivo: Descrever o procedimento, avaliar a viabilidade e perviedade em longo prazo da dilatação biliar trans-hepática percutânea usando a técnica de dilatação por balão superdimensionado para o tratamento em uma única etapa de estenose biliar anastomótica benigna após cirurgia hepatobiliar. Materiais e Métodos: Este estudo retrospectivo de dois centros incluiu 16 casos consecutivos de estenoses bilioentéricas benignas sintomáticas. A dilatação das estenoses com superdimensionamento do balão de 40-50% foi realizada após avaliação pré-procedimento do diâmetro do ducto biliar por tomografia computadorizada ou ressonância magnética e um dreno externo foi colocado. Os sintomas clínicos e exames laboratoriais foram avaliados a cada três meses após a remoção do dreno, enquanto o acompanhamento radiológico foi realizado com ressonância magnética em 30 dias e tomografia computadorizada em 6 e 12 meses. Resultados: O tempo médio de seguimento foi de 31,8 ± 8,15 meses. As estimativas de perviedade em um, dois e três anos foram 88,2%, 82,4% e 82,4%; respectivamente. Houve uma complicação importante, com pequena deiscência da anastomose biliodigestiva, que exigiu prolongamento do tempo de permanência do dreno externo. Complicações menores ocorreram em dois casos, um pequeno hematoma peri-hepático e uma trombose segmentar do ramo portal esquerdo e nenhum deles necessitou de intervenção adicional. Conclusão: A técnica de dilatação com balão superdimensionado para o tratamento de estenoses biliares anastomóticas benignas foi viável para o tratamento de estenoses anastomóticas bilioentéricas benignas. A técnica parece estar associada a altas taxas de perviedade e de sucesso clínico no longo prazo.

Efficacy and safety of endoscopic sphincterotomy joint balloon dilatation in treatment of common bile duct calculi / 中国医师杂志

Objective To explore the therapeutic efficacy and safety of endoscopic sphincterotomy joint balloon dilatation in the treatment of common bile duct calculi in order to reduce the recent and long-term complications.Methods A total of 120 cases of patients with common bile duct calculi was grouped into three groups:endoscopic sphincterotomy joint balloon dilatation,endoscopic sphincterotomy (EST),and endoscopic papillo-sphincter balloon dilatation (EPBD).The operative efficacy of three groupsand the incidence of postoperative immediate and long-term complications were observed and compared.Results No difference was found in total stone-free rate among three groups.No significant difference was found in a stone-free rate and lithotripsy rate between endoscopic sphincterotomy joint balloon dilatation and EST groups (P ＞ 0.05),however,those parameters in the former two groups were better than EPBD group (P ＜ 0.05).The incidence of postoperative bleeding in the endoscopic sphincterotomy joint balloon dilatation group is lower than EST group.The incidence of postoperative pancreatitis in the endoscopic sphincterotomy joint balloon dilatation and EST groups was lower than the EPBD group(P ＜ 0.05).For the long-term complications,the incidence of reflux cholangitis in the endoscopic sphincterotomy joint balloon dilatation group was lower than the EST group (P ＜ 0.05).The recurrence rate of postoperative bile duct calculi in the endoscopic sphincterotomy joint balloon dilatation group was lower than the EST and EPBD groups.Conclusions For the endoscopic sphincterotomy joint balloon dilatation in the treatment of common bile duct calculi,its curative effect was the same as the EST,but better than EPBD; it had a lower incidence of immediate and long-term complications than EST and EPBD.