Hepaticojejunostomy anastomotic strictures (HJASs) often occur as an adverse event
after biliary reconstructive surgery [1]. Balloon stricture dilation via balloon enteroscopy-assisted endoscopic retrograde
cholangiopancreatography (BE-ERCP) is a standard treatment for HJAS [2]; however, there is no dedicated balloon catheter for HJAS treatment. Conventional
papillary/bile duct dilation balloons are generally used, but they are often too long
for HJASs. Long balloons can unnecessarily expand the normal intrahepatic bile duct
and require there to be sufficient distance between the anastomotic site and the tip
of the scope, which can be challenging to achieve. In contrast, short balloons tend
to slip during inflation, especially during BE-ERCP because of the absence of a forceps
elevator.
To address these problems, a novel, dedicated balloon catheter (RIGEL Balloon Dilatation
Catheter; Japan Lifeline Co., Ltd., Tokyo, Japan) has been developed ([Fig. 1]), which has a very short balloon, measuring 15 mm, and an elastic band attached
in the middle. The central part expands with a delay, preventing slippage.
Fig. 1 Photographs of the novel dedicated balloon catheter, which has: a a very short length of 15 mm; b,c a 5-mm elastic ring-band at the center, which means the central part of the balloon
expands with a delay during inflation, thereby preventing slippage.
An 88-year-old woman who had undergone pancreaticoduodenectomy developed cholangitis.
A short-type single-balloon enteroscope was inserted, and the HJAS was detected. After
inserting a guidewire through the stricture, we inserted the 8-mm diameter novel balloon
catheter over the guidewire. The central part of the novel balloon expanded with an
appropriate delay during inflation, achieving full expansion without slippage, while
maintaining a position close to the anastomosis ([Fig. 2]; [Video 1]). The stricture was finally well recanalized, and no adverse events occurred.
Fig. 2 Endoscopic images showing: a the novel balloon inserted and positioned with its center at the stricture after
biliary cannulation through the hepaticojejunostomy anastomotic stricture had been
performed during short-type single-balloon enteroscopy; b expansion of the center of the novel balloon after an appropriate delay, which allows
full expansion without slippage, while maintaining a position close to the anastomosis.
Treatment of a hepaticojejunostomy anastomotic stricture using a novel dedicated nonslip
balloon catheter of 8-mm diameter during balloon enteroscopy-assisted endoscopic retrograde
cholangiopancreatography.Video 1
This novel balloon catheter offers a new device option for BE-ERCP. Its unique short
length and antislip features make it suitable for the treatment of HJASs.
Endoscopy_UCTN_Code_TTT_1AP_2AD
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