Choledochoscopic high-frequency needle-knife electrotomy for treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy

English version České info

Background:
Anastomotic stricture is a complex and substantial complication following Roux-en-Y hepaticojejunostomy. Initially, endoscopic and percutaneous approaches are often attempted, but the gold standard remains surgical biliary reconstruction, especially for refractory stricture. However, this solution leaves much room for improvement, due to the challenging nature of the biliary reconstruction procedure, in which anastomotic stricture may still occur.

Aims:
To investigate the feasibility and effectiveness of choledochoscopic high-frequency needle-knife electrotomy as an intervention in the treatment of anastomotic strictures following Roux-en-Y hepaticojejunostomy.

Methods:
From February 2010 to October 2014, clinical data was collected and retrospectively compared for patients who underwent balloon dilation or/and choledochoscopic high-frequency needle-knife electrotomy for the treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy.

Results:
A total of 38 patients underwent successful choledochoscopic treatment and all the anastomotic strictures were removed successfully, 19 of which were treated with electrotomy, 7 with balloon dilation, and 12 with both electrotomy and balloon dilation. Among these groups,the average operating times were 6.9 ± 2.4 min,10.1 ± 6.8 min, and 20.2 ± 13.5 min, respectively. The average stent supporting times were 6.3 ± 0.7 months, 6.5 ± 0.6 months, and 6.1 ± 0.4 respectively. The mean follow-up after stent removal was 42.1 ± 27.4 months, and in 26.3 % (5/19), 28.5 % (2/7) and 16.7 % (2/12) of cases, recurrent anastomotic stricture occurred. Of these 9 total patients with recurrent anastomotic, two patients were successfully rescued by full-covered self-expanding removable metal stents and 7 patients by electrotomy combined with balloon dilation.

Conclusions:
Choledochoscopic high-frequency needle-knife electrotomy is both feasible and safe in the treatment of anastomotic stricture after Roux-en-Y hepaticojejunostomy, with a similar long-term outcome to balloon dilation in treating anastomotic stricture after Roux-en-Y hepaticojejunostomy. A combination of choledochoscopic electrotomy concurrent with balloon dilation should be recommended based on the low rate of recurrence.

Keywords:
Anastomotic stricture, Hepaticojejunostomy, Balloon dilatation, Electrotomy, Choledochoscope

Autoři: Yu-Long Yang† ^*; Cheng Zhang†; Ping Wu; Yue-Feng Ma; Jing-Yi Li; Hong-Wei Zhang; Li-Jun Shi; Mei-Ju Lin; Ying Yu
Vyšlo v časopise: BMC Gastroenterology 2016, 16:54
Kategorie: Technical advance
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12876-016-0465-9

© 2016 Yang et al.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0465-9

Souhrn

Keywords:
Anastomotic stricture, Hepaticojejunostomy, Balloon dilatation, Electrotomy, Choledochoscope

Zdroje

1. Felder SI, Menon VG, Nissen NN, Margulies DR, Lo S, Colquhoun SD. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction. JAMA Surg. 2013;148(3):253–7. doi:10.1001/jamasurg.2013.601.

2. Xia HT, Dong JH, Yang T, Liang B, Zeng JP. Selection of the surgical approach for reoperation of adult choledochal cysts. J Gastrointest Surg. 2015;19(2):290–7. doi:10.1007/s11605-014-2684-0.

3. Benkabbou A, Castaing D, Salloum C, Adam R, Azoulay D, Vibert E. Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries. Surgery. 2013;153(1):95–102. doi:10.1016/j.surg.2012.06.028.

4. Hajjar NA, Tomuş C, Mocan L, Mocan T, Graur F, Iancu C, Zaharie F. Management of bile duct injuries following laparoscopic cholecystectomy: long-term outcome and risk factors influencing biliary reconstruction. Chirurgia (Bucur). 2014;109(4):493–9.

5. Pottakkat B, Sikora SS, Kumar A, Saxena R, Kapoor VK. Recurrent bile duct stricture: causes and long-term results of surgical management. J Hepatobiliary Pancreat Surg. 2007;14(2):171–6.

6. Bismuth H, Franco D, Corlette MB, Hepp J. Long term results of Roux-en-Y hepaticojejunostomy. Surg Gynecol Obstet. 1978;146(2):161–7.

7. Stefanini P, Carboni M, Patrassi N, Basoli A, de Bernardinis G, Negro P. Rouxen-Y hepaticojejunostomy: a reappraisal of its indications and results. Ann Surg. 1975;181(2):213–9.

8. Yan JQ, Peng CH, Ding JZ, Yang WP, Zhou GW, Chen YJ, Tao ZY, Li HW. Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury. World J Gastroenterol. 2007;13(48):6598–602.

9. Mercado MA, Chan C, Orozco H, Cano-Gutiérrez G, Chaparro JM, Galindo E, Vilatobá M, Samaniego-Arvizu G. To stent or not to stent bilioenteric anastomosis after iatrogenic injury: a dilemma not answered? Arch Surg. 2002;137(1):60–3.

10. Ruiz J, Torres R. Translaparoscopic jejunal approach for benign stricture of Roux-en-Y hepaticojejunostomy. Surg Endosc. 2001;15(5):518.

11. Curcio G, Traina M, Miraglia R, Tarantino I, Barresi L, Granata A, Luca A, Gridelli B. Endoscopy after radiology: two-step combined therapy for biliary stricture after Roux-en-Y hepaticojejunostomy. Dig Endosc. 2012;24(4):271–4. doi:10.1111/j.1443-1661.2011.01203.x.

12. Yang Y, Zhang C, Zhao G, Wu P, Ma Y, Zhang H, Shi L, Li J, Lin M, Yang S, Lu Y. Choledochoscopic high-frequency needle-knife electrotomy as an effective treatment for intrahepatic biliary strictures. J Gastroenterol Hepatol. 2015 Mar 12. doi: 10.1111/jgh.12951

13. von Renteln D, Riecken B, Ulmer M, Caca K. Biliary stenting and successful intentional stent retrieval after 6 months in a benign stricture following hepaticojejunostomy. Endoscopy. 2007;39 Suppl 1:E335–6. doi:10.1055/s-2007-966833.

14. Jan YY, Chen MF, Hung CF. Balloon dilatation of intrahepatic duct and biliary-enteric anastomosis strictures. Long term results. Int Surg. 1994; 79(2):103–5.

15. Vos PM, van Beek EJ, Smits NJ, Rauws EA, Gouma DJ, Reeders JW. Percutaneous balloon dilatation for benign hepaticojejunostomy strictures. Abdom Imaging. 2000;25(2):134–8.

16. Luo ZL, Cheng L, Ren JD, Tang LJ, Wang T, Tian FZ. Progressive balloon dilatation following hepaticojejunostomy improves outcome of bile duct stricture after iatrogenic biliary injury. BMC Gastroenterol. 2013;22(13):7. doi:10.1186/1471-230X-13-70.

17. Schumacher B, Othman T, Jansen M, Preiss C, Neuhaus H. Long-term followup of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy. 2001;33(5):409–15.

18. Köcher M, Cerná M, Havlík R, Král V, Gryga A, Duda M. Percutaneous treatment of benign bile duct strictures. Eur J Radiol. 2007;62(2):170–4.

19. Li FY, Cheng NS, Mao H, Jiang LS, Cheng JQ, Li QS, Munireddy S. Significance of controlling chronic proliferative cholangitis in the treatment of hepatolithiasis. World J Surg. 2009;33(10):2155–60. doi:10.1007/s00268-009-0154-8.

20. Burden VG. Observations on the histologic and pathologic anatomy of the hepatic, cystic, and common bile ducts. Ann Surg. 1925;82(4):584–97.

21. Nakanuma Y, Yamaguchi K, Ohta G, Terada T. Pathologic features of hepatolithiasis in Japan. Hum Pathol. 1988;19(10):1181–6.