Successful Biliary Re-Cannulation and Neo-Anastomosis Creation in Complete Bile Duct Occlusion or Disruption Using a Combination of Interventional Radiology and Endoscopic Techniques: A Case Series.

AIMS: Biliary strictures are a known complication of hepatobiliary and pancreatic surgeries. This retrospective descriptive series highlights six consecutive patients with complete bile duct occlusion or disruption who required a multidisciplinary approach with a combination of interventional radiology (IR) and endoscopic techniques to either re-cannulate or create a neo-anastomosis in the biliary system.

METHODS AND RESULTS: The biliary system was either re-cannulated or a neo-anastomosis was created using a small gauge needle (N = 3), a rendezvous procedure (N = 1), a radiofrequency ablation wire (N = 1), and the back end of a wire (N = 1). There was one major adverse event (bacteremia requiring antibiotic therapy). Follow-up protocol included scheduled biliary catheter checks every 10-12 weeks to assess biliary duct patency or tract maturation. At each interval, cholangioscopy and cholangioplasty were performed as indicated. Once the tract demonstrated maturity and liver function tests normalized, the catheter was converted to an external-only drain. Patients who successfully tolerated a capping trial of the external biliary catheter subsequently underwent catheter removal. Patients who remained asymptomatic with normal liver function tests following catheter removal were considered to have achieved catheter-free status.

CONCLUSION: Four of the six patients are biliary catheter free, while two of the patients are progressing toward being catheter free. Additional data from larger series and planned prospective registries should help delineate standards for outcomes and patient management.