Double-balloon endoscopic retrograde cholangiography can make a reliable diagnosis and good prognosis for postoperative complications of congenital biliary dilatation

Abstract

Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. This retrospective study included 28 patients who underwent DBERC (44 procedures) after radical surgery for CBD between January 2011 and December 2019. Strictures were diagnosed as "bile duct strictures" if endoscopy confirmed the presence of bile duct mucosa between the stenotic and anastomotic regions, and as "anastomotic strictures" if the mucosa was absent. The median patient age was 4 (range 0-67) years at the time of primary surgery for CBD and 27.5 (range 8-76) years at the time of DBERC. All anastomotic strictures could be treated with only by 1-2 courses of balloon dilatation of DBERC, while many bile duct strictures (41.2%) needed ≥ 3 treatments, especially those who underwent operative bile duct plasty as the first treatment (83.3%). Although the study was limited by the short follow-up period after DBERC treatment, DBERC is recommended as the first-line treatment for hepatolithiasis associated with biliary and anastomotic strictures in CBD patients, and it can be safely performed multiple times.

Figure 1

Case 6 from Table 1. (a) No abnormalities are seen in MRCP 20 years after radical surgery. (b) Twenty-five years after radical surgery, MRCP identifies intrahepatic bile duct dilatation and stones. (c) Bile duct mucosa is found in front of the stenosis. There is no stenosis at the anastomosis (dotted line). The stricture is noted in the second part of the bile duct. (arrow) Lithectomy is performed at DBERC. DBERC double-balloon endoscopic retrograde cholangiography, MRCP magnetic resonance cholangiopancreatography.

Figure 2

Case 3 from Table 4. (a) Stones are identified on computed tomography twelve years after radical surgery. (b) An anastomotic stricture was identified using DBERC. (dotted line) Balloon dilation and lithectomy were performed. DBERC double-balloon endoscopic retrograde cholangiography.

Figure 3

(a) Strictures diagnosed as “bile duct strictures.” No strictures at the anastomosis (dotted line) and bile duct mucosa (arrow) are found between the stenotic and anastomotic regions. The figure on the right shows the bile duct after balloon dilatation of strictures (narrowed bile duct) with DBERC. (b) Stricture diagnosed as an “anastomotic stricture.” The site of anastomosis is indicated with a dotted line. There is no bile duct mucosa between the stenotic and anastomotic regions. The figure on the right shows the bile duct after balloon dilation of the stenotic anastomosis. There are no strictures at the bile duct. (c) Strictures diagnosed as “anastomotic and bile duct strictures.” The anastomosis site is indicated with a dotted line. There is no bile duct mucosa between the stenotic and anastomotic regions. The stricture was diagnosed as an “anastomotic stricture.” The figure in the middle shows the bile duct after dilation of the anastomosis, bile duct strictures (arrow) are also seen. The figure on the right shows the bile duct after balloon dilation of the narrowed segment of the bile duct (arrow). DBERC double-balloon endoscopic retrograde cholangiography.