Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

Abstract

Background/aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.

Methods: We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.

Results: Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01-7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85-6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.

Conclusion: Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

Keywords: Adverse events; Balloon dilation; Balloon-assisted enteroscopy; Endoscopic retrograde cholangiopancreatography; Hepaticojejunostomy anastomotic stricture.

Fig. 1.

Balloon dilation on fluoroscopy. (A) No balloon notch. (B) Residual balloon notch (arrow).

Fig. 2.

Patient flow chart. BAE, balloon-assisted enteroscopy; ERCP, endoscopic retrograde cholangiopancreatography; HJAS, hepaticojejunostomy anastomosis stricture; EUS-BD, endoscopic ultrasound-guided biliary drainage; PTBD, percutaneous transhepatic biliary drainage.

Fig. 3.

Time to recurrent stenosis after first balloon dilation for HJAS. HJAS, hepaticojejunostomy anastomosis stricture; NA, not available; CI, confidence interval.

Fig. 4.

Time to recurrent HJAS based on presence of residual balloon notch. HJAS, hepaticojejunostomy anastomosis stricture; NA, not available; CI, confidence interval.