Percutaneous Management of Benign Biliary Enteric Anastomotic Strictures after Iatrogenic Bile Duct Injuries

Background: To assess the technical success, complications and reintervention rate of percutaneous transhepatic balloon dilatation (PTBD) of biliary enteric anastomotic strictures (BES). Methods: A retrospective review of patients who underwent PTBD for benign resistant BES, were previously treated for iatrogenic bile duct injuries, from December 2004 to January 2016 was performed. Diagnostic transhepatic cholangiogram was performed to assess level of obstruction. Strictures were dilated using 8-12 mm diameter balloons followed by placement of 8-10 Fr internal-external drainage catheters, which're removed after 3-5 days post-PTBD cholangiogram. Follow up by clinical assessment, liver function tests and ultrasound was done. Fischer exact test was used to determine if there was a significant association between PTBD sessions and recurrent strictures. Results: In total, 37 patients underwent PTBD including 10 (27%) males and 27 (73%) females. Mean age was 41.3 yrs.(range 23-70 yrs.). Out of these, 29 (78.4%) were treated with choledochojejunostomy and 8 (21.6%) with hepaticojejunostomy. 100% success was achieved in all the PTBD sessions. 19 (51.3%) patients were treated with a single PTBD session. Mean follow-up time was 36 months (Range 1–75 months). 2 (5.4%) patients were lost to follow up after first session of PTBD. 18 (48.7%) patients needed reintervention, out of these, 11 (29.7%) were symptom free after second session on 3 year follow up, 3 (8.1%) were symptom free after the third session of PTBD. No significant difference in risk of recurrent strictures after 1^st and 2^nd PTBD sessions [18 (48.7%) vs. 7 (39%); P < 0.5716]. In 4 (10.9%) patients, the symptoms persisted and the stricture recurred even after third session and were treated by placing metallic stent. In total, 3 (8.1%) patients got complicated with the stone formation; in 2 (5.4%) patients it was successfully removed percutaneously and in 1 (2.7%) percutaneous attempt failed followed by surgical removal. Conclusions: PTBD is a safe and useful treatment option for BES for long-term symptoms free time-period. However, there is no significant difference in developing recurrent BES after PTBD sessions. Few patients with resistant strictures might require stent placement.

 

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Publication History

Article published online:
26 April 2021