Treatment of biliary strictures with fully covered self-expandable metal stents after pancreaticoduodenectomy

Abstract

Background and study aims Anastomotic stricture is a late complication after biliary reconstructive surgery, but standard treatments are currently lacking. We selected patients who had undergone pancreaticoduodenectomy and Child’s procedure, and aimed to evaluate the safety and efficacy of temporary placement of fully covered self-expandable metal stents (FCSEMSs) to treat postoperative anastomotic stricture.

Patients and methods This study retrospectively analyzed 13 patients who underwent treatment with FCSEMSs for anastomotic stricture between June 2011 and March 2016. We evaluated technical and clinical success, complications, duration of patency after FCSEMS removal, and re-stenosis.

Results All of the anastomotic strictures were improved by FCSEMS placement and luminal patency was maintained throughout the follow-up period, with no complications. After 2 months, the FCSEMSs were removed endoscopically in nine patients, and in four patients the stent had been expelled spontaneously per rectum. Median duration of follow-up was 225 days (range 30 – 935 days). No re-stenosis occurred in any of the 13 cases following stent removal.

Conclusion Deployment of FCSEMSs for anastomotic stricture offers a safe and promising treatment that may replace percutaneous transhepatic biliary drainage and deployment of multiple plastic stents as the first-line treatment.

• References

• 1 Lee AY, Gregorius J, Kerlan Jr RK. et al. Percutaneous transhepatic balloon dilation of biliary enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries. PLoS One 2012; 7: e46478
• 2 Kim JH, Lee SK, Kim MH. 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. Gastrointest Endosc 2003; 58: 733-738
• 3 Bonnel DH, Fingerhut AL. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients. Am J Surg 2012; 203: 675-683
• 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 Miyata E, Yamauchi H, Kida M. et al. Successful endoscopic dilation of severe bilioenteric strictures with a wire-guided diathermic dilator and short-type single-balloon enteroscope. Endoscopy 2015; 47: E94-95
• 6 Weber A, Rosca B, Neu B. et al. Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) in patients with benign bilioenterostomy stricture. Endoscopy 2009; 41: 323-328
• 7 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
• 8 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
• 9 Zepeda-Gómez S, Baron TH. Benign biliary strictures: current endoscopic management. Nat Rev Gastroenterol Hepatol 2011; 8: 573-581
• 10 Mahajan A, Ho H, Sauer B. et al. Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation. Gastrointest Endosc 2009; 70: 303-309
• 11 Sauer P, Chahoud F, Gotthardt D. et al. Temporary placement of fully covered self-expandable metal stents in biliary complications after liver transplantation. Endoscopy 2012; 44: 536-538
• 12 Pitt HA, Miyamoto T, Parapatis SK. et al. Factors influencing outcome in patients with postoperative biliary strictures. Am J Surg 1982; 144: 14-21
• 13 Suman L, Civelli EM, Cozzi G. et al. Long-term results of balloon dilatation of benign bile duct strictures. Acta Radiol 2003; 44: 147-150