Percutaneous treatment of benign bilioenteric anastomotic strictures: temporary covered stent placement versus balloon dilatation

• Published in: European radiology 2019-05, Vol.29 (5), p.2690-2697
• Main Authors: Yun, Gabin, Yoon, Chang Jin, Seong, Nak Jong
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anastomosis; Anastomosis, Surgical - adverse effects; Benign; Bile Ducts - surgery; Catheterization - methods; Constriction, Pathologic - etiology; Constriction, Pathologic - therapy; Diagnostic Radiology; Dilatation - methods; Drainage - methods; Female; Humans; Imaging; Implants; Internal Medicine; Interventional; Interventional Radiology; Jejunum; Jejunum - surgery; Male; Medical instruments; Medicine; Medicine & Public Health; Middle Aged; Migration; Neuroradiology; Patients; Percutaneous treatment; Placement; Radiology; Retrospective Studies; Stents; Stents - adverse effects; Stricture; Surgical implants; Treatment Outcome; Ultrasound; Wound drainage
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-018-5776-5

Objectives To compare percutaneous temporary covered stent placement with balloon dilatation in the treatment of benign stricture of bilioenteric anastomosis. Methods From November 2004 to August 2017, 56 patients with benign bilioenteric anastomotic strictures underwent percutaneous transhepatic treatment. A temporary covered stent designed for spontaneous migration was placed in 23 patients (stent group). Balloon dilatation was performed in 33 patients (balloon group). The technical success, percutaneous transhepatic biliary drainage (PTBD) indwelling times, stent indwelling times and patency rates were retrospectively compared between the two groups. Results Technical success was achieved in all patients in the stent group and in 96.8% (32/33) of patients in the balloon group. All stents spontaneously migrated into the jejunum, and stent indwelling times were 3–9 months (median, 6 months). The PTBD indwelling time was shorter for the stent group than for the balloon group (median, 7 vs. 71 days, p  = 0.001). Recurrent strictures occurred more frequently in the balloon group than in the stent group (54.5% vs. 13.0%, p =  0.002; hazard ratio 3.7). The 1- and 3-year primary patency rates were 90.2% and 84.9% for the stent group and 75.1% and 52.8% for the balloon group, respectively ( p  = 0.04). Conclusions Percutaneous temporary covered stenting is an effective treatment in patients with benign bilioenteric anastomotic strictures. It provides longer patency and shorter PTBD indwelling time compared with balloon dilatation. Key Points • A temporary covered stent designed for spontaneous migration is a feasible and effective treatment for patients with benign bilioenteric anastomotic strictures. • Percutaneous temporary covered stents provide longer patency and shorter drainage catheter indwelling time compared with conventional balloon dilatation. • A covered stent with flared ends spontaneously migrated after 3–9 months.