Treatment of completely obstructed benign biliary strictures with magnetic compression anastomosis: follow-up results after recanalization

• Published in: Gastrointestinal endoscopy 2017-05, Vol.85 (5), p.1057-1066
• Main Authors: Jang, Sung Ill, MD, Lee, Kwang-Hun, MD, PhD, Yoon, Hong Jin, MD, Lee, Dong Ki, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomosis, Surgical; Biliary Tract Surgical Procedures; Cholestasis - therapy; Constriction, Pathologic - therapy; Device Removal; Drainage; Endoscopy, Digestive System - methods; Female; Gastroenterology and Hepatology; Humans; Liver Transplantation; Magnets; Male; Middle Aged; Postoperative Complications - therapy
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2016.08.047

Background and Aims Although nonsurgical methods produce high clinical success rates in the treatment of benign biliary stricture (BBS), conventional methods are not always successful in cases of severe biliary stricture or complete obstruction. Therefore, the efficacy of magnetic compression anastomosis (MCA) for treatment of refractory BBS was evaluated in a single-center, nonrandomized study. Methods MCA was performed in patients with BBS that was not resolved by conventional endoscopic or percutaneous treatments. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and the other advanced through 1 of 3 different routes. After magnet approximation and recanalization, an internal drainage catheter was placed for 6 months. Results This study followed 39 patients who underwent MCA after the development of postoperative or traumatic strictures. Recanalization was achieved successfully in 35 patients. There was an acceptable procedure-related adverse event of mild cholangitis in 1 patient and no procedure-related mortalities. The average elapsed time from magnet approximation to removal was 57.4 days (range, 13-182 days), and the mean follow-up period after recanalization was 41.9 months (range, 7.1-73.4 months). Restenosis after MCA recurred in 1 patient, and partial restenosis occurred in another patient, but recanalization in these patients was successful using a guidewire via the percutaneous and endoscopic tracts. Conclusions MCA represents an alternative nonsurgical recanalization method for BBSs that cannot be treated by conventional methods. The rate of stricture recurrence after MCA was lower than that after conventional methods, likely because of the creation of a new fistula tract instead of dilation of a previous stricture.