Long-term Results of Percutaneous Biliary Balloon Dilatation and Sequential Upsizing of Silastic Transanastomotic Stents for Benign Hepaticojejunostomy Strictures: A Tertiary Care Center Experience

Purpose Benign biliary strictures are efficiently managed by creation of hepaticojejunostomy (HJ). Stricture at HJ anastomotic site presents a difficult problem in management. To determine the safety, efficacy, and long-term results of percutaneous biliary balloon dilatation (PBBD) and sequential upsizing of silastic transanastomotic stents (STS) for benign HJ strictures.

Materials and Methods PBBD was performed after traversing HJ strictures, followed by placement of STS from both the right and the left ductal system or from the right ductal system. These silastic catheters were fashioned as transanastomotic stents and had been upsized sequentially with a larger bore over a period of 1 year at 3 months intervals. Two patients had undergone retrograde placement through transjejunal puncture. A total of 135 patients (59 male, 76 female; age range, 6–71 years; mean age 41.64 year), who underwent HJ had been recruited for the study between 2007 and 2014. Mean maximum diameter achieved at the end of 1 year was 34.3 French. Mean procedure time and mean fluoroscopic time were 49.5 minutes (31–64 min) and 15.33 minutes (13.6–18.2 minutes), respectively. Cholangiogram, balloon manometric perfusion tests, or spy cholangioscopy were done before removal of STS to ensure adequate decompression of strictures. The primary outcome measure was the absence of clinical biliary obstruction symptoms at 24 months.

Results The overall technical and clinical success rates were 98.5 and 97.7%, respectively. The primary outcome measure was achieved in 98.5% of patients. The mean follow-up period and mean primary patency durations were 43.15 months and 42.76 months, respectively. Procedure-related mortality and major morbidity rates were 0 and 3.7%, respectively. Weight gain by the patients during upsizing in a year was significant (p = 0.001).

Conclusion PBBD and sequential upsizing of silastic transanastomotic stents for benign HJ strictures is a safe and effective procedure with excellent outcome measures.

Fig. 1 PBBD across stricture. PBBD, percutaneous biliary balloon dilatation.

Fig. 2 Balloon sweep of stones.

No conflict of interest has been declared by the author(s).