Surgical Techniques Development, Vol. 14, Pages 24: Clinical Outcomes After Endoscopic Retrograde Cholangiopancreatography Using Balloon-Assisted Enteroscopy for Benign Anastomotic Stricture of Choledochojejunostomy: A Retrospective Study
Surgical Techniques Development doi: 10.3390/std14030024
Authors:
Koh Kitagawa
Shohei Asada
Jun-ichi Hanatani
Yuki Motokawa
Yui Osaki
Tomihiro Iwata
Kosuke Kaji
Akira Mitoro
Hitoshi Yoshiji
Background/Objectives: Benign choledochojejunal anastomotic stricture (CJS) is a major late adverse event (AE) after choledochojejunostomy. An endoscopic method using balloon-assisted enteroscopy endoscopic retrograde cholangiopancreatography (BAE-ERCP) was recently developed for CJS. Methods: We retrospectively reviewed 45 patients (98 cases) who underwent BAE-ERCP for benign CJS. The primary endpoint was the success rate of ERCP. The secondary endpoints were AEs and the recurrence rate of benign CJS. Results: ERCP was successful in 36 patients (80%). Balloon dilation of the anastomosis was performed in all 36 patients in whom ERCP was successful, and temporary plastic stent (PS) placement was performed in 20 of these patients (55.6%). Three cases of PS migration and one case of portal vein thrombosis occurred as mild AEs. However, one case of intestinal perforation required emergency surgery for repair. In univariate analysis, proficiency in ERCP procedures (p = 0.019) and surgery at our hospital (p = 0.010) emerged as major factors affecting the procedural success. In univariate analysis, only the early onset of CJS within 400 days after choledochojejunostomy was extracted as a significant factor for the early recurrence of CJS after ERCP (p = 0.036). Conclusions: To ensure successful BAE-ERCP for CJS, it is essential to have proficiency in the ERCP and collect as much detailed information about prior surgery as possible before the procedure. Additionally, the risk of CJS recurrence might be high in patients in whom CJS develops early after surgery.
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Koh Kitagawa www.mdpi.com
