The Utility of Biliary Manometry in Assessing Early Catheter Removal After Percutaneous Balloon Dilatation of Hepaticojejunostomy Strictures

Sunil Kumar; Selvamurugan Vignesh; Deb K Boruah; Archna Gupta; Rajanikant R Yadav; Vinay Kumar Kapoor; Anu Behari; Supriya Sharma

doi:10.7759/cureus.22761

The Utility of Biliary Manometry in Assessing Early Catheter Removal After Percutaneous Balloon Dilatation of Hepaticojejunostomy Strictures

Cureus. 2022 Mar 2;14(3):e22761. doi: 10.7759/cureus.22761. eCollection 2022 Mar.

Authors

Sunil Kumar¹, Selvamurugan Vignesh², Deb K Boruah³, Archna Gupta¹, Rajanikant R Yadav¹, Vinay Kumar Kapoor⁴, Anu Behari⁵, Supriya Sharma⁵

Affiliations

¹ Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND.
² Department of Interventional Radiology, Meenakshi Mission Hospital, Madurai, IND.
³ Department of Radiodiagnosis, Lakhimpur Medical College, Lakhimpur, IND.
⁴ Department of Surgical Gastroenterology, Mahatma Gandhi Medical College & Hospital, Jaipur, IND.
⁵ Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND.

Abstract

Background and objective Percutaneous balloon dilatation followed by long-term internal-external biliary catheter (IEBC) placement is the standard radiological management for postoperative hepaticojejunostomy (HJ) strictures. The treatment is considered successful when cholangiography shows a free flow of contrast across the anastomosis and the patient passes a "clinical test". However, these tests may not be suitable predictors of long-term successful treatment outcomes. The purpose of this study was to assess the utility of biliary manometry in the evaluation of successful treatment outcomes after HJ stricture dilatation and IEBC placement and its efficacy as a tool for early catheter removal. Patients and methods A total of 14 patients underwent percutaneous balloon dilatation of HJ strictures with IEBC placement. A two-to-three-month interval was maintained between sessions of exchanging or upsizing IEBCs. Biliary manometry was performed after a mean duration of 6.3 months. Intra-biliary pressure of <15 mmHg was considered as the success threshold. Results Among the 14 patients, 11 patients passed initial manometry and had their IEBCs removed and were followed up for a mean duration of 47.8 months. Of these, one patient developed biliary obstruction after six months and underwent repeat HJ stricture dilatation and long-term IEBC placement. Three patients failed manometry and underwent re-dilatation of HJ strictures with IEBC placement. Using Kaplan-Meier survival analysis, the probability of patients remaining stricture-free after HJ stricture dilatation was found to be 100% at three months and 91% at six, 12, 18, 24, 36, and 47.8 months. Conclusion Biliary manometry prevents subjective variations in determining treatment endpoints and helps to assess early catheter removal after percutaneous balloon dilatation of HJ strictures.

Keywords: biliary manometry; iatrogenic bile duct strictures; internal external biliary catheter; percutaneous balloon dilatation; percutaneous transhepatic biliary drainage; ptbd; roux-en-y hepaticojejunostomy.