Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple's procedure: A retrospective study

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Abstract

Background: Endoscopic retrograde cholangiography using a short double-balloon endoscope (DB-ERC) is a promising minimally-invasive method for accessing hepaticojejunostomy (HJ) anastomosis in patients with surgically altered anatomy. We aimed to evaluate the immediate and long-term outcomes of balloon dilatation for benign HJ anastomotic stricture (HJAS) in patients who had previously undergone Whipple's procedure using a DB-ERC. Methods: We conducted a retrospective analysis of 46 patients who underwent balloon dilatation alone with a DB-ERC for benign HJAS between November 2008 and November 2014. The median follow-up duration was 3.5 (interquartile range [IQR], 1.9-5.1) years. Results: The technical and clinical success rates were 100%, and adverse events occurred in 7% (3/46, cholangitis). The median hospitalization period was seven (IQR, 5-10) days. Of 42 patients (91%) followed-up for > 1 year, 24 (51%) had recurrent HJAS at a median of 1.2 (IQR, 0.6-2.9) years after balloon dilatation. The cumulative anastomotic patency rates at 1, 2, and 3 years were 73, 55, and 49%, respectively. In univariate analysis, early stricture formation (< 1 year) was a risk factor for recurrent stenosis, although no statistically significant risk factors were observed in multivariate analysis. Conclusions: Endoscopic balloon dilatation with DB-ERC for benign HJAS is effective and safe, having good immediate technical success and few adverse events. Further improvements to this procedure are needed to prevent recurrent HJAS.

Original languageEnglish
Article number14
JournalBMC Gastroenterology
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 18 2018

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Double-Balloon Enteroscopy
Dilatation
Pathologic Constriction
Retrospective Studies
Cholangitis
Cholangiography
Endoscopes
Anatomy
Hospitalization
Multivariate Analysis

Keywords

  • Balloon dilatation
  • Choledochojejunostomy
  • Double-balloon enteroscopy
  • Pancreatoduodenectomy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{c71f7d3489674c31b737dd845eca4604,
title = "Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple's procedure: A retrospective study",
abstract = "Background: Endoscopic retrograde cholangiography using a short double-balloon endoscope (DB-ERC) is a promising minimally-invasive method for accessing hepaticojejunostomy (HJ) anastomosis in patients with surgically altered anatomy. We aimed to evaluate the immediate and long-term outcomes of balloon dilatation for benign HJ anastomotic stricture (HJAS) in patients who had previously undergone Whipple's procedure using a DB-ERC. Methods: We conducted a retrospective analysis of 46 patients who underwent balloon dilatation alone with a DB-ERC for benign HJAS between November 2008 and November 2014. The median follow-up duration was 3.5 (interquartile range [IQR], 1.9-5.1) years. Results: The technical and clinical success rates were 100{\%}, and adverse events occurred in 7{\%} (3/46, cholangitis). The median hospitalization period was seven (IQR, 5-10) days. Of 42 patients (91{\%}) followed-up for > 1 year, 24 (51{\%}) had recurrent HJAS at a median of 1.2 (IQR, 0.6-2.9) years after balloon dilatation. The cumulative anastomotic patency rates at 1, 2, and 3 years were 73, 55, and 49{\%}, respectively. In univariate analysis, early stricture formation (< 1 year) was a risk factor for recurrent stenosis, although no statistically significant risk factors were observed in multivariate analysis. Conclusions: Endoscopic balloon dilatation with DB-ERC for benign HJAS is effective and safe, having good immediate technical success and few adverse events. Further improvements to this procedure are needed to prevent recurrent HJAS.",
keywords = "Balloon dilatation, Choledochojejunostomy, Double-balloon enteroscopy, Pancreatoduodenectomy",
author = "Sho Mizukawa and Koichiro Tsutsumi and Hironari Kato and Shinichiro Muro and Yutaka Akimoto and Daisuke Uchida and Kazuyuki Matsumoto and Takeshi Tomoda and Shigeru Horiguchi and Hiroyuki Okada",
year = "2018",
month = "1",
day = "18",
doi = "10.1186/s12876-018-0742-x",
language = "English",
volume = "18",
journal = "BMC Gastroenterology",
issn = "1471-230X",
publisher = "BioMed Central",
number = "1",

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TY - JOUR

T1 - Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple's procedure

T2 - A retrospective study

AU - Mizukawa, Sho

AU - Tsutsumi, Koichiro

AU - Kato, Hironari

AU - Muro, Shinichiro

AU - Akimoto, Yutaka

AU - Uchida, Daisuke

AU - Matsumoto, Kazuyuki

AU - Tomoda, Takeshi

AU - Horiguchi, Shigeru

AU - Okada, Hiroyuki

PY - 2018/1/18

Y1 - 2018/1/18

N2 - Background: Endoscopic retrograde cholangiography using a short double-balloon endoscope (DB-ERC) is a promising minimally-invasive method for accessing hepaticojejunostomy (HJ) anastomosis in patients with surgically altered anatomy. We aimed to evaluate the immediate and long-term outcomes of balloon dilatation for benign HJ anastomotic stricture (HJAS) in patients who had previously undergone Whipple's procedure using a DB-ERC. Methods: We conducted a retrospective analysis of 46 patients who underwent balloon dilatation alone with a DB-ERC for benign HJAS between November 2008 and November 2014. The median follow-up duration was 3.5 (interquartile range [IQR], 1.9-5.1) years. Results: The technical and clinical success rates were 100%, and adverse events occurred in 7% (3/46, cholangitis). The median hospitalization period was seven (IQR, 5-10) days. Of 42 patients (91%) followed-up for > 1 year, 24 (51%) had recurrent HJAS at a median of 1.2 (IQR, 0.6-2.9) years after balloon dilatation. The cumulative anastomotic patency rates at 1, 2, and 3 years were 73, 55, and 49%, respectively. In univariate analysis, early stricture formation (< 1 year) was a risk factor for recurrent stenosis, although no statistically significant risk factors were observed in multivariate analysis. Conclusions: Endoscopic balloon dilatation with DB-ERC for benign HJAS is effective and safe, having good immediate technical success and few adverse events. Further improvements to this procedure are needed to prevent recurrent HJAS.

AB - Background: Endoscopic retrograde cholangiography using a short double-balloon endoscope (DB-ERC) is a promising minimally-invasive method for accessing hepaticojejunostomy (HJ) anastomosis in patients with surgically altered anatomy. We aimed to evaluate the immediate and long-term outcomes of balloon dilatation for benign HJ anastomotic stricture (HJAS) in patients who had previously undergone Whipple's procedure using a DB-ERC. Methods: We conducted a retrospective analysis of 46 patients who underwent balloon dilatation alone with a DB-ERC for benign HJAS between November 2008 and November 2014. The median follow-up duration was 3.5 (interquartile range [IQR], 1.9-5.1) years. Results: The technical and clinical success rates were 100%, and adverse events occurred in 7% (3/46, cholangitis). The median hospitalization period was seven (IQR, 5-10) days. Of 42 patients (91%) followed-up for > 1 year, 24 (51%) had recurrent HJAS at a median of 1.2 (IQR, 0.6-2.9) years after balloon dilatation. The cumulative anastomotic patency rates at 1, 2, and 3 years were 73, 55, and 49%, respectively. In univariate analysis, early stricture formation (< 1 year) was a risk factor for recurrent stenosis, although no statistically significant risk factors were observed in multivariate analysis. Conclusions: Endoscopic balloon dilatation with DB-ERC for benign HJAS is effective and safe, having good immediate technical success and few adverse events. Further improvements to this procedure are needed to prevent recurrent HJAS.

KW - Balloon dilatation

KW - Choledochojejunostomy

KW - Double-balloon enteroscopy

KW - Pancreatoduodenectomy

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U2 - 10.1186/s12876-018-0742-x

DO - 10.1186/s12876-018-0742-x

M3 - Article

C2 - 29347923

AN - SCOPUS:85040722133

VL - 18

JO - BMC Gastroenterology

JF - BMC Gastroenterology

SN - 1471-230X

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