Endoscopy 2019; 51(04): S25-S26
DOI: 10.1055/s-0039-1681243
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Video EUS 1 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

ANTEROGRADE BILIARY DRAINAGE AS SECOND STEP AFTER EUS HEPATICOGASTROSTOMY (ABD-HG) FOR MANAGING BENIGN BILIO-DIGESTIVE ANASTOMOTIC STRICTURES

JM Gonzalez
1   Gastroenterology, Hôpital Nord, AP-HM, Aix Marseille Univ., Marseille, France
,
J Bodiou
1   Gastroenterology, Hôpital Nord, AP-HM, Aix Marseille Univ., Marseille, France
,
M Gasmi
1   Gastroenterology, Hôpital Nord, AP-HM, Aix Marseille Univ., Marseille, France
,
M Barthet
1   Gastroenterology, Hôpital Nord, AP-HM, Aix Marseille Univ., Marseille, France
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Introduction and aims:

Benign strictures of bilio-digestive anastomoses (ABDS) are classical complications after biliary surgery. We propose an approach in two consecutive steps:

  1. EUS-guided HG to create an access to the biliary tree;

  2. anterograde treatment of the stricture.

The objectives were to evaluate the feasibility, the safety, and the efficacy of this strategy.

Methods:

Monocentric retrospective study including patients with ABDS managed by ADB-HG. One month after the first step was scheduled an anterograde treatment being:

  1. anastomotic dilatation using 8 mm balloon + double pigtail stents (DPS) placement if the ABDS was crossed;

  2. anterograde cholangisocopy (+ electro-hydraulic lithotrity) in case of lithiasis.

Results:

12 patients (mean of 61 years) were included. Nine had a hepatico-jejunal stricture, 2 biliary stricture with duodenal occlusion, and one a posthepatectomy defect of the convergence. The symptoms were 50% of cholangitis, 50% of jaundice.

First step: the technical and clinical success were 100% (SEMS placement in 9 cases, DPS and/or naso-biliary drain in 2, and dilation + DPS in one case. There were 4 post-operative adverse events (3 cholangitis, 1 abscess) managed conservatively.

Second step: was done after 7 weeks average. The ABDS was crossed in 36.4%, allowing for dilation and DPS placement. In other cases (63.6%), hepatico-gastric stents were placed (4 DPS; 4 SEMS). Two patients had anterograde cholangioscopy with electro-hydaulic lithotrity for macrolithiasis (Video).

Then, a mean of 4.4 subsequent ambulatory endoscopies were performed, with final crossing and dilation of the ABDS in 75% (+DPS). There was no complication. In a mean follow-up of 100 weeks [12 – 213]. One patient had one dilatation without recurrence, the 11 others undergo stent exchanges every year and remain asymptomatic.

Conclusion:

The management of ABDS with this two-steps approach, allowed for stricture repermeabilization rate of 75% and constant clinical symptoms regression.