Treating Biliary-Enteric Anastomotic Strictures with Enteroscopy-ERCP Requires Fewer Procedures than Percutaneous Transhepatic Biliary Drains

被引:19
作者
Hammad, Hazem [1 ]
Brauer, Brian C. [1 ]
Smolkin, Maximiliano [2 ]
Ryu, Robert [4 ]
Obuch, Joshua [3 ]
Shah, Raj J. [1 ]
机构
[1] Univ Colorado, Div Gastroenterol & Hepatol, Anschutz Med Campus, Aurora, CO 80045 USA
[2] Univ Colorado, Dept Med, Anschutz Med Campus, Aurora, CO USA
[3] Geisinger Wyoming Valley Med Ctr, Div Gastroenterol, Wilkes Barre, PA USA
[4] Univ Colorado, Dept Radiol, Anschutz Med Campus, Aurora, CO USA
关键词
Roux-en-Y hepaticojejunostomy; ERCP; Enteroscopy; Anastomotic stricture; Percutaneous transhepatic cholangiogram; PTC; DOUBLE-BALLOON ENTEROSCOPY; BILE-DUCT INJURY; ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY; LIVER-TRANSPLANT RECIPIENTS; LAPAROSCOPIC CHOLECYSTECTOMY; SINGLE-BALLOON; HEPATICOJEJUNOSTOMY; COMPLICATIONS; MANAGEMENT; DILATION;
D O I
10.1007/s10620-019-05670-y
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Biliary-enteric anastomotic strictures (AS) in long-limb surgical biliary bypass (LLBB) require percutaneous transhepatic biliary drains (PTBD), enteroscopy-assisted ERCP (E-ERCP), or surgical revision. Aim To compare E-ERCP and PTBD for AS treatment. Methods E-ERCP stricturoplasty included dilation, cautery, and stent; PTBD included balloon dilation and serial drain upsizing events. Results From May 2008 to October 2015, 71 patients (37 M, median age 52) had E-ERCP (n = 45) or PTBD (n = 26) for AS in Roux-en-Y hepaticojejunostomy: liver transplant (n = 28), cholecystectomy injury revision (n = 21), other (n = 13) or Whipple's resection (n = 9). Median follow-up is 11 months (range 1-56) in 67 (94%) patients. Technical success, clinical improvement, and adverse events between E-ERCP and PTBD were similar (76% vs. 77%, p = 0.89; 82% vs. 85%, p = 0.80, and 6% vs. 5%, p = 0.60, respectively). However, E-ERCP had fewer post-procedural hospitalization days (0.2 +/- 0.65 vs. 4.5 +/- 10, p = 0.0001), mean procedures (4.4 +/- 6.3 vs. 9.5 +/- 8, p = 0.006), and median months of treatment to resolve AS (1, range 1-22 vs. 7, range 3-23; p = 0.003). Two patients in PTBD group required surgery. Conclusions (1) Technical success and clinical improvement are seen in the majority of LLBB patients with biliary-enteric AS undergoing E-ERCP or PTBD. (2) E-ERCP is associated with fewer procedures, post-procedure hospitalization days, and months to resolve AS. When expertise is available, E-ERCP to identify and treat AS should be considered as an alternative to PTBD.
引用
收藏
页码:2638 / 2644
页数:7
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