Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

  • Takafumi Mie (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Takashi Sasaki (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Takeshi Okamoto (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Tsuyoshi Takeda (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Chinatsu Mori (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Yuto Yamada (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Takaaki Furukawa (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Akiyoshi Kasuga (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Masato Matsuyama (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Masato Ozaka (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research) ;
  • Naoki Sasahira (Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research)
  • Received : 2022.08.20
  • Accepted : 2022.11.02
  • Published : 2024.03.30
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Abstract

Background/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS. Methods: We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020. Results: Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01-7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85-6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively. Conclusions: Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

Keywords

References

  1. House MG, Cameron JL, Schulick RD, et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006;243:571-578.
  2. Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K, et al. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg 2007;11:1704-1711.
  3. Dimou FM, Adhikari D, Mehta HB, et al. Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery 2016;160:691-698.
  4. Primrose JN, Fox RP, Palmer DH, et al. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol 2019;20:663-673.
  5. Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 2016;388:248-257.
  6. Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 2018;379:2395-2406.
  7. Motoi F, Kosuge T, Ueno H, et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol 2019;49:190-194.
  8. Ikeda M, Nakachi K, Konishi M, et al. Adjuvant S-1 versus observation in curatively resected biliary tract cancer: a phase III trial (JCOG1202: ASCOT). Jpn J Clin Oncol 2022;4_suppl:382.
  9. Inoue Y, Saiura A, Oba A, et al. Neoadjuvant gemcitabine and nab-paclitaxel for borderline resectable pancreatic cancers: intention-to-treat analysis compared with upfront surgery. J Hepatobiliary Pancreat Sci 2021;28:143-155.
  10. Tsutsumi K, Kato H, Yabe S, et al. A comparative evaluation of treatment methods for bile duct stones after hepaticojejunostomy between percutaneous transhepatic cholangioscopy and peroral, short double-balloon enteroscopy. Therap Adv Gastroenterol 2017;10:54-67.
  11. Shimatani M, Hatanaka H, Kogure H, et al. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy: a multicenter prospective study in Japan. Am J Gastroenterol 2016;111:1750-1758.
  12. Tomoda T, Tsutsumi K, Kato H, et al. Outcomes of management for biliary stricture after living donor liver transplantation with hepaticojejunostomy using short-type double-balloon enteroscopy. Surg Endosc 2016;30:5338-5344.
  13. Itokawa F, Itoi T, Ishii K, et al. Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection. Dig Endosc 2014;26 Suppl 2:136-143.
  14. Shimatani M, Matsushita M, Takaoka M, et al. Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series. Endoscopy 2009;41:849-854.
  15. Tsujino T, Yamada A, Isayama H, et al. Experiences of biliary interventions using short double-balloon enteroscopy in patients with Roux-en-Y anastomosis or hepaticojejunostomy. Dig Endosc 2010;22:211-216.
  16. Mizukawa S, Tsutsumi K, Kato H, et al. Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple's procedure: a retrospective study. BMC Gastroenterol 2018;18:14.
  17. Tomoda T, Kato H, Miyamoto K, et al. Comparison between endoscopic biliary stenting combined with balloon dilation and balloon dilation alone for the treatment of benign hepaticojejunostomy anastomotic stricture. J Gastrointest Surg 2020;24:1352-1358.
  18. Sato T, Kogure H, Nakai Y, et al. Endoscopic treatment of hepaticojejunostomy anastomotic strictures using fully-covered metal stents. Dig Endosc 2021;33:451-457.
  19. Tomoda T, Kato H, Ueki T, et al. Efficacy of double-balloon enteroscopy-assisted endoscopic balloon dilatation combined with stent deployment for hepaticojejunostomy anastomotic stricture. Dig Endosc 2022;34:604-611.
  20. Inoue T, Ibusuki M, Kitano R, et al. Balloon enteroscopy-assisted radial incision and cutting method for refractory hepaticojejunostomy anastomotic strictures. Endoscopy 2019;51:566-570.
  21. Lindstrom O, Udd M, Rainio M, et al. Benign biliary strictures treated with biodegradable stents in patients with surgically altered anatomy using double balloon enteroscopy. Scand J Gastroenterol 2020;55:1225-1233.
  22. Tsutsumi K, Kato H, Sakakihara I, et al. Dilation of a severe bilioenteric or pancreatoenteric anastomotic stricture using a Soehendra Stent Retriever. World J Gastrointest Endosc 2013;5:412-416.
  23. Sato T, Kogure H, Nakai Y, et al. Double-balloon endoscopy-assisted treatment of hepaticojejunostomy anastomotic strictures and predictive factors for treatment success. Surg Endosc 2020;34:1612-1620.
  24. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010;71:446-454.
  25. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013;48:452-458.
  26. Sato T, Kogure H, Nakai Y, et al. A prospective study of fully covered metal stents for different types of refractory benign biliary strictures. Endoscopy 2020;52:368-376.
  27. Mukund A, Rajesh S, Agrawal N, et al. Percutaneous management of resistant biliary-enteric anastomotic strictures with the use of a combined cutting and conventional balloon cholangioplasty protocol: a single-center experience. J Vasc Interv Radiol 2015;26:560-565.
  28. Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 2001;4:200-206.
  29. Ogura T, Okuda A, Higuchi K. Endoscopic ultrasound-guided hepaticogastrostomy for hepaticojejunostomy stricture using a one-step stent deployment technique (with video). J Hepatobiliary Pancreat Sci 2021;28:e34-e35.
  30. Pawa R, Jiang D, Gilliam J, et al. EUS-guided hepaticogastrostomy for management of cholangitis, hepatolithiasis, and anastomotic stricture after Roux-en-Y hepaticojejunostomy. VideoGIE 2021;6:225-227.
  31. Katanuma A, Hayashi T, Kin T, et al. Interventional endoscopic ultrasonography in patients with surgically altered anatomy: techniques and literature review. Dig Endosc 2020;32:263-274.
  32. Kuhn JP, Busemann A, Lerch MM, et al. Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts compared with patients with dilated intrahepatic bile ducts. AJR Am J Roentgenol 2010;195:851-857.
  33. Morita S, Kitanosono T, Lee D, et al. Comparison of technical success and complications of percutaneous transhepatic cholangiography and biliary drainage between patients with and without transplanted liver. AJR Am J Roentgenol 2012;199:1149-1152.
  34. Chantarojanasiri T, Ratanachu-Ek T, Pausawasdi N. What you need to know before performing endoscopic ultrasound-guided hepaticogastrostomy. Clin Endosc 2021;54:301-308.