ABSTRACT
Background and study aims The increase in hepaticojejunostomies has led to an increase in benign strictures of the anastomosis. Double balloon enteroscopy-assisted ERCP (DBE-ERCP) and percutaneous transhepatic biliary drainage (PTBD) are treatment options; however, there is lack of long-term outcomes, with no consensus on management. We performed a retrospective study assessing the outcomes of patients referred for endoscopic management of hepaticojejunostomy anastomotic strictures (HJAS). Patients and methods All consecutive patients at a tertiary institution underwent endoscopic intervention for suspected HJAS between 2009 and 2021 were enrolled. Results Eighty-two subjects underwent DBE-ERCP for suspected HJAS.âThe technical success rate was 77â% (63/82). HJAS was confirmed in 41 patients. The clinical success rate for DBE-ERCP ± PTBD was 71â% (29/41). DBE-ERCP alone achieved clinical success in 49â% of patients (20/41). PTBD was required in 49â% (20/41). Dual therapy was required in 22â% (9/41). Those with liver transplant had less technical success compared to other surgeries (72.1â% vs 82.1â% P â=â0.29), less clinical success with DBE-ERCP alone (40â% vs 62.5â% P â=â0.16) and required more PTBD (56â% vs 37.5â% P â=â0.25). All those with ischemic biliopathy (nâ=â9) required PTBD for clinical success, required more DBE-ERCP (4.4 vs 2.0, Pâ=â0.004), more PTBD (4.7 vs 0.3, P â<â0.0001), longer treatment duration (181.6 vs 99.5 days P â=â0.12), and had higher rates of recurrence (55.6â% vs 30.3â% P â=â0.18) compared to those with HJAS alone. Liver transplant was the leading cause of ischemic biliopathy (89â%). The overall adverse event rate was 7â%. Conclusions DBE-ERCP is an effective diagnostic and therapeutic tool in those with altered gastrointestinal anatomy and is associated with low complication rates.