Percutaneous management of benign biliary strictures with balloon dilation and self-expanding metallic stents

Background and aims: Post liver transplant biliary anastomotic strictures have traditionally been treated with balloon dilation and multiple plastic stents. Fully covered self-expandable metallic stents may be used as an initial alternative or after multiple plastic stents failure. Refractory strictures can occur in 10–22% and require revisional surgery. Alternatively, cholangioscopy allows direct visualization and therapeutic approaches. We aimed to assess the feasibility, safety, and efficacy of balloon dilation combined with cholangioscopy-guided steroid injection for the treatment of refractory anastomotic biliary strictures. Methods: Three post-orthotopic liver transplant patients who failed standard treatment of their biliary anastomotic strictures underwent endoscopic retrograde cholangiopancreatography with balloon dilation followed by cholangioscopy-guided steroid injection at a tertiary care center. Patients had follow-up with images and laboratorial tests to evaluate for residual stricture. Results: Technical success of balloon dilation + cholangioscopy-guided steroid injection was achieved in all patients. Cholangioscopy permitted accurate evaluation of bile ducts and precise localization for steroid injection. No adverse events occurred. Mean follow-up was 26 months. Two patients are stent free and remain well in follow-up, with no signs of biliary obstruction. No further therapeutic endoscopic procedures or revisional surgery were required. One patient did not respond to balloon dilation + cholangioscopy-guided steroid injection after 11 months of follow-up and required repeat balloon dilation of new strictures above the anastomosis. Conclusion: Cholangioscopy-guided steroid injection combined with balloon dilation in the treatment of refractory post liver transplant strictures is feasible and safe. This method may be used as a rescue alternative before surgical approach. Randomized controlled trials comparing balloon dilation + cholangioscopy-guided steroid injection to fully covered self-expandable metallic stents are needed to determine the role of this treatment for anastomotic biliary strictures.

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Metallic stents in benign biliary strictures: Three-year follow-up

CardioVascular and Interventional Radiology ◽

10.1007/bf02734119 ◽

1992 ◽

Vol 15 (6) ◽

pp. 360-366 ◽

Cited By ~ 49

Author(s):

Francesca Maccioni ◽

Michele Rossi ◽

Filippo Maria Salvatori ◽

Paolo Ricci ◽

Mario Bezzi ◽

...

Keyword(s):

Metallic Stents ◽

Biliary Strictures ◽

Benign Biliary Strictures

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Percutaneous Management of Benign Biliary Strictures

Seminars in Interventional Radiology ◽

10.1055/s-0041-1731087 ◽

2021 ◽

Vol 38 (03) ◽

pp. 291-299

Author(s):

Adam Fang ◽

Il Kyoon Kim ◽

Ifechi Ukeh ◽

Vahid Etezadi ◽

Hyun S. Kim

Keyword(s):

Treatment Options ◽

Balloon Dilation ◽

Percutaneous Transhepatic Cholangiography ◽

Team Approach ◽

Biliary Strictures ◽

Surgical Interventions ◽

Benign Biliary Strictures ◽

Elevated Liver Enzymes ◽

Biodegradable Stents ◽

Asymptomatic Disease

AbstractBenign biliary strictures are often due to a variety of etiologies, most of which are iatrogenic. Clinical presentation can vary from asymptomatic disease with elevated liver enzymes to obstructive jaundice and recurrent cholangitis. Diagnostic imaging methods, such as ultrasound, multidetector computed tomography, and magnetic resonance imaging (cholangiopancreatography), are used to identify stricture location, extent, and possible source of biliary obstruction. The management of benign biliary strictures requires a multidisciplinary team approach and include endoscopic, percutaneous, and surgical interventions. Percutaneous biliary interventions provide an alternative diagnostic and therapeutic approach, especially in patients who are not amenable to endoscopic evaluation. This review provides an overview of benign biliary strictures and percutaneous management by interventional radiologists. Diagnostic evaluation with percutaneous transhepatic cholangiography and treatment options, including biliary drainage, balloon dilation, retrievable/biodegradable stents, and other innovative minimally invasive options, are discussed.

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