Clin Endosc.  2016 Nov;49(6):530-532. 10.5946/ce.2016.125.

Percutaneous Transhepatic Cholangioscopy in Bilioenteric Anastomosis Stricture

• Oh HC

• KMID: 2383447
• DOI: http://doi.org/10.5946/ce.2016.125

Abstract

Bilioenteric anastomosis strictures are a serious complication of biliary surgery, and often result in recurrent cholangitis, choledocholithiasis, biliary cirrhosis, and hepatic failure. Bilioenteric reconstructive surgery is the standard treatment of choice for such complications. However, percutaneous transhepatic cholangioscopy (PTCS), also known as per-oral endoscopic-guided intervention, is a less invasive procedure that is becoming an increasingly popular alternative. This review describes the PTCS procedure (including the preparation process), as well as the diagnostic and therapeutic role of PTCS in bilioenteric anastomosis strictures.

Keyword

Cholangioscopy; Constriction, pathologic; Anastomosis

MeSH Terms

Cholangitis
Choledocholithiasis
Constriction, Pathologic*
Liver Cirrhosis, Biliary
Liver Failure

Figure

• 

  Fig. 1. Cholangioscopy image shows malignant tumor vessels at the biliary stricture site.

• 

  Fig. 2. (A) Cholangiography images show a bilioenteric anastomosis stricture and a marked proximal dilatation of the bile duct. (B) A pinpoint stricture (arrow) was recanalized by guide wire manipulation. (C) Balloon dilation was performed. Adapted from Yang et al. [15].

Reference

1. Warren KW, Mountain JC, Midell AI. Management of strictures of the biliary tract. Surg Clin North Am. 1971; 51:711–731.

2. Pitt HA, Miyamoto T, Parapatis SK, Tompkins RK, Longmire WP Jr. Factors influencing outcome in patients with postoperative biliary strictures. Am J Surg. 1982; 144:14–21.

3. Collins PG, Gorey TF. Iatrogenic biliary stricture: presentation and management. Br J Surg. 1984; 71:980–982.

4. Pellegrini CA, Thomas MJ, Way LW. Recurrent biliary stricture. Patterns of recurrence and outcome of surgical therapy. Am J Surg. 1984; 147:175–180.

5. Pitt HA, Kaufman SL, Coleman J, White RI, Cameron JL. Benign postoperative biliary strictures. Operate or dilate? Ann Surg. 1989; 210:417–425.

6. Röthlin MA, Löpfe M, Schlumpf R, Largiadèr F. Long-term results of hepaticojejunostomy for benign lesions of the bile ducts. Am J Surg. 1998; 175:22–26.

7. Tocchi A, Costa G, Lepre L, Liotta G, Mazzoni G, Sita A. The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. Ann Surg. 1996; 224:162–167.

8. Seo DW, Lee SK, Kim MH, et al. Cholangioscopy. Seoul: Koonja Publishing Inc.;2002.

9. Oh HC, Lee SK, Lee TY, et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy. 2007; 39:731–736.

10. Choi JH, Lee SK. Percutaneous transhepatic cholangioscopy: does its role still exist? Clin Endosc. 2013; 46:529–536.

11. Seo DW, Lee SK, Yoo KS, et al. Cholangioscopic findings in bile duct tumors. Gastrointest Endosc. 2000; 52:630–634.

12. Kim HJ, Kim MH, Lee SK, Yoo KS, Seo DW, Min YI. Tumor vessel: a valuable cholangioscopic clue of malignant biliary stricture. Gastrointest Endosc. 2000; 52:635–638.

13. Bak B, Ornsholt J. Non-absorbable suture material as a nidus for the formation of common bile duct stones. Ann Chir Gynaecol. 1985; 74:146–147.

14. Martinez J, Combs W, Brady PG. Surgical clips as a nidus for biliary stone formation: diagnosis and therapy. Am J Gastroenterol. 1995; 90:1521–1524.

15. Yang DH, Lee SK, Moon SH, et al. Percutaneous transhepatic cholangioscopic intervention in the management of complete membranous occlusion of bilioenteric anastomosis: report of two cases. Gut Liver. 2009; 3:352–355.

16. Lim JU, Joo KR, Cha JM, et al. Needle-knife fistulotomy with percutaneous transhepatic cholangioscopy for managing complete bilioenteric anastomosis occlusion. Surg Laparosc Endosc Percutan Tech. 2014; 24:e10–e12.

17. Kim JH, Lee SK, Kim MH, et al. Percutaneous transhepatic cholangioscopic treatment of patients with benign bilio-enteric anastomotic strictures. Gastrointest Endosc. 2003; 58:733–738.

18. Kim JH, Gwon DI, Ko GY, et al. Temporary placement of retrievable fully covered metallic stents versus percutaneous balloon dilation in the treatment of benign biliary strictures. J Vasc Interv Radiol. 2011; 22:893–899.

19. Franzini T, Moura R, Rodela G, et al. A novel approach in benign biliary stricture: balloon dilation combined with cholangioscopy-guided steroid injection. Endoscopy. 2015; 47 Suppl 1:E571–E572.

20. Jang SI, Kim JH, Won JY, et al. Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation. Gastrointest Endosc. 2011; 74:1040–1048.

21. Jang SI, Rhee K, Kim H, et al. Recanalization of refractory benign biliary stricture using magnetic compression anastomosis. Endoscopy. 2014; 46:70–74.