Transhepatic Percutaneous Sustained Dilation with Multiple Catheters for the Management of Hepaticojejunostomy Benign Stricture.

Background

Benign biliary strictures (BBS) befall in ∼7%-23% after hepaticojejunostomy and in 0.3%-0.6% after cholecystectomies. Their treatment options include surgical, endoscopic, and percutaneous management. The percutaneous approach is an excellent mini-invasive option including balloon dilation, biodegradable stents, and sustained dilation, a procedure born endoscopically. However, when the endoscopic approach fails or it is not available, it is possible to perform it percutaneously. Aim: To estimate the technical and clinical success of sustained percutaneous dilation with multiple catheters (SPDMC) in hepaticojejunostomy strictures and the percentage of complications and recurrence. Materials and

Methods

We conducted a retrospective study, from a prospective database from January 2010 to March 2019, of 17 patients with postoperative BBS who failed to percutaneous pneumatic balloon dilation and underwent SPDMC with a mean follow-up of 2 years.

Results

Seventeen patients between 28 and 71 years of age underwent SPMDC with technical success of 100%; the average number of catheters used was 5.59 (95% confidence interval [CI] 5.12-6.06) achieving a dilatation diameter of 16.15 mm (95% CI 14.71-17.60), and the therapeutic success rate was 71%, with recurrences of stricture and complications of 29% and 18%, respectively. The mean time with SPMDC was 7.06 months (95% CI 5.56-8.56). The median follow-up after dilation was 16 months, with an average of 27.75 months (95% CI 14.15-41.34).

Conclusion

SPMDC is a feasible technique with a high technical success rate, therapeutic success rate, and low morbidity and mortality.