Double-balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato-biliary-pancreatic operation

Dig Endosc. 2015 Jan;27(1):146-54. doi: 10.1111/den.12332. Epub 2014 Nov 3.

Abstract

Background and aim: There have been few reports on the success rate of balloon dilation and stent deployment using endoscopic retrograde cholangiopancreatography by double-balloon enteroscopy (DBE-ERCP) or on the follow-up period after stent removal in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis. The present study was designed to evaluate the usefulness of DBE-ERCP in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis.

Methods: Forty-four patients with stenosis of choledochojejunal anastomosis underwent DBE-ERCP at Okayama University Hospital between April 2008 and January 2012 (107 procedures). Rates of reaching choledochojejunal anastomosis, stent deployment, and restenosis after stent removal were retrospectively evaluated.

Results: Insertion of DBE into the choledochojejunal anastomotic site succeeded in 38 of 44 patients (86.4%), and anastomotic dilation and stent deployment succeeded in 36 of 44 patients (81.8%). In 32 of 44 patients (72.7%), their anastomotic stenoses were improved, and they achieved stent removal. After stent removal, restenosis of choledochojejunal anastomosis was detected in seven of 32 patients; however, the resolution of restenosis was achieved in all seven of those patients.

Conclusion: Dilation of choledochojejunal anastomosis combined with stent deployment using DBE-ERCP seems to be a viable first-line treatment for patients with stenosis of choledochojejunal anastomosis.

Keywords: choledochojejunal anastomotic stenosis; dilation; double-balloon enteroscopy (DBE); endoscopic biliary stenting; endoscopic retrograde cholangiopancreatography (ERCP).

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical / methods*
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Common Bile Duct / surgery*
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / surgery
  • Double-Balloon Enteroscopy
  • Female
  • Follow-Up Studies
  • Humans
  • Jaundice, Obstructive / surgery*
  • Jejunum / surgery*
  • Male
  • Middle Aged
  • Reoperation
  • Retrospective Studies
  • Treatment Failure