Safety and Efficacy of Covered Self-Expandable Metallic Stent for Choledochojejunal Anastomotic Stricture: A Multi-Center Retrospective Cohort Study

• Published in: Digestive diseases and sciences 2024-09, Vol.69 (9), p.3481-3487
• Main Authors: Iwasa, Yuhei, Iwashita, Takuji, Iwata, Keisuke, Okuno, Mitsuru, Shimojo, Kota, Uemura, Shinya, Tezuka, Ryuichi, Senju, Akihiko, Iwata, Shota, Shimizu, Masahito
• Format: Article
• Language: English
• Subjects: Aged; Anastomosis, Surgical - adverse effects; Biochemistry; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - methods; Choledochostomy - adverse effects; Choledochostomy - instrumentation; Choledochostomy - methods; Constriction, Pathologic - surgery; Dilatation - instrumentation; Dilatation - methods; Endoscopy; Female; Gastroenterology; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Postoperative Complications - etiology; Postoperative Complications - therapy; Recurrence; Retrospective Studies; Self Expandable Metallic Stents - adverse effects; Transplant Surgery; Treatment Outcome
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-024-08561-z

Background Benign choledochojejunal anastomotic stricture (CJS) is a complication of pancreaticoduodenectomy and choledochojejunostomy. Typically managed with endoscopic balloon dilatation, CJS has a high recurrence rate. Covered metallic stent (CMS) placement is a potential alternative; however, a comprehensive evaluation is lacking. Objectives The aim of this study was to evaluate the treatment outcomes of CMS placement in patients with CJS. Methods We retrospectively analyzed patients who underwent balloon dilation via endoscopic retrograde cholangiopancreatography using a double-balloon endoscope for CJS between October 2010 and October 2023. The study outcomes included technical and clinical success rates, adverse event rates, choledochojejunal anastomotic stricture recurrence rates, and time to recurrence for balloon dilation and CMS treatment for CJS. Results There were 43 patients, 55 procedures (40 balloon dilation and 15 CMS placement). The technical and clinical success rates were 100% for both treatments. Recurrence of CJS was observed in 35% (14/40) of the patients in the balloon dilation group. The recurrence rate was significantly higher in the balloon dilation group than in the CMS group (35% vs. 0%, p  = 0.006). The time to CJS recurrence was significantly shorter in the balloon dilation group than in the covered metallic stent group (NR vs. NR, p  = 0.03). Conclusion Placement of CMS for treating patients with CJS was demonstrated to be an effective and safe method with a lower recurrence rate than balloon dilation.