Balloon enteroscopy-assisted radial incision and cutting method for refractory hepaticojejunostomy anastomotic strictures

Abstract

Background Balloon enteroscopy-assisted balloon dilation and temporary biliary stent placement are effective for hepaticojejunostomy anastomotic strictures (HJAS), but the re-stenosis rates are relatively high. We examined the feasibility and efficacy of a novel treatment technique for refractory HJAS, called balloon enteroscopy-assisted radial incision and cutting (BE-RIC).

Methods Between January 2016 and June 2018, 11 patients with refractory HJAS that recurred after balloon dilation and/or stent placement, underwent BE-RIC. We evaluated the technical success, clinical success, adverse events, and re-stenosis rates associated with BE-RIC.

Results The technical success rate of BE-RIC was 91 % (10/11). Clinical success was achieved in all patients who underwent technically successful procedures. The procedure-related adverse event rate was 9 % (1/11). No re-stenosis was observed during the follow-up period; 9 patients were followed up for more than 6 months, and of these, 5, 4, and 2 patients were followed up for more than 12, 18, and 24 months, respectively, without re-stenosis.

Conclusions BE-RIC for refractory HJAS showed favorable results. BE-RIC might be a useful option for treating refractory HJAS.

• References

• 1 Dimou FM, Adhikari D, Mehta HB. et al. Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery 2016; 160: 691-698
• 2 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
• 3 Yane K, Katanuma A, Maguchi H. et al. Short-type single-balloon enteroscope-assisted ERCP in postsurgical altered anatomy: potential factors affecting procedural failure. Endoscopy 2017; 49: 69-74
• 4 Sakakihara I, Kato H, Muro S. et al. Double-balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato-biliary-pancreatic operation. Dig Endosc 2015; 27: 146-154
• 5 Tsou YK, Lee MS, Chen KF. et al. Double-balloon enteroscopy-assisted endoscopic retrograde cholangiography for Roux-en-Y reconstruction patients with papilla of Vater or bilioenteric anastomosis. Scand J Gastroenterol 2016; 51: 95-102
• 6 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
• 7 van Boeckel PG, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. Curr Treat Options Gastroenterol 2015; 13: 47-58
• 8 Muto M, Ezoe Y, Yano T. et al. Usefulness of endoscopic radial incision and cutting method for refractory esophagogastric anastomotic stricture (with video). Gastrointest Endosc 2012; 75: 965-972
• 9 Kiriyama S, Takada T, Strasberg SM. et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013; 20: 24-34
• 10 Parlak E, Ciçek B, Dişibeyaz S. et al. Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy. Surg Endosc 2010; 24: 466-470
• 11 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. 02) 136-143
• 12 Osera S, Ikematsu H, Odagaki T. et al. Efficacy and safety of endoscopic radial incision and cutting for benign severe anastomotic stricture after surgery for lower rectal cancer (with video). Gastrointest Endosc 2015; 81: 770-773
• 13 Harada K, Kawano S, Hiraoka S. et al. Endoscopic radial incision and cutting method for refractory stricture of a rectal anastomosis after surgery. Endoscopy 2015; 47 (Suppl. 01) E552-553
• 14 Asayama N, Nagata S, Shigita K. et al. Effectiveness and safety of endoscopic radial incision and cutting for severe benign anastomotic stenosis after surgery for colorectal carcinoma: a three-case series. Endosc Int Open 2018; 6: E335-339
• 15 Kataoka K, Aoyama I, Mizusawa J. et al. A randomized controlled Phase II/III study comparing endoscopic balloon dilation combined with steroid infection versus radial incision and cutting combined with steroid infection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207. Jpn J Clin Oncol 2015; 45: 385-389