Percutaneous transhepatic cholangioscopic treatment of patients with benign bilio-enteric anastomotic strictures

• Published in: Gastrointestinal endoscopy 2003-11, Vol.58 (5), p.733-738
• Main Authors: Kim, Jung-Ho, Lee, Sung Koo, Kim, Myung-Hwan, Song, Moon Hee, Park, Do Hyun, Kim, Sun Young, Lee, Sang Soo, Seo, Dong-Wan, Bae, Jong Seok, Kim, Hyun Jun, Han, Jimin, Sung, Kyu-Bo, Min, Young-Il
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anastomosis, Surgical; Bile Ducts; Biological and medical sciences; Catheterization - methods; Choledochostomy; Cholestasis - therapy; Cholestasis, Extrahepatic - pathology; Cholestasis, Extrahepatic - therapy; Endoscopy, Digestive System - methods; Female; Follow-Up Studies; Gallstones - therapy; Humans; Liver; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Postoperative Complications - surgery; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Tropical medicine
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(03)02144-8

Percutaneous transhepatic cholangioscopy is a nonoperative method for accessing bilio-enteric anastomotic strictures that cannot be reached via the transpapillary route. This study evaluated the immediate and long-term results of treatment via percutaneous transhepatic cholangioscopy of patients with benign bilio-enteric anastomotic strictures. A retrospective analysis was conducted of 21 patients who, between October 1994 and March 2001, had undergone percutaneous transhepatic cholangioscopy for bilio-enteric anastomotic strictures. Follow-up ranged from 12 to 79 months (mean 33.3 months). The initial technical success rate was 100%, and the short-term morbidity and mortality rates were, respectively, 14.3% and 0%. However, strictures recurred in 8 patients (38.1%) at a mean of 17.1 months (range 2-38 months). The success rate exclusive of patients with recurrent strictures was 61.9%, and the overall success rate was 81.0% when the procedures were repeated. The long-term morbidity rate was 38.1%, but most complications resolved with conservative treatment. In 17 patients (81.0%), strictures were complicated by biliary stones, and these were successfully treated via percutaneous transhepatic cholangioscopy (stone removal rate 94.1%, recurrence rate 37.5%). Percutaneous transhepatic cholangioscopy–based treatment of patients with benign bilio-enteric anastomotic strictures is safe and effective. This minimally invasive method frequently can be used as a substitute for surgery.