Endoscopic treatment of bile duct stones with benign choledochojejunal anastomotic stenosis

Akihiko Kida; Yukihiro Shirota; Hideaki Shunto; Noriho Iida; Jun Asai; Hajime Takatori; Koichiro Matsuda; Kaheita Kakinoki; Akito Sakai; Takeshi Urabe; Taro Yamashita

doi:10.1016/j.gie.2024.05.003

Endoscopic treatment of bile duct stones with benign choledochojejunal anastomotic stenosis

Gastrointest Endosc. 2024 May 8:S0016-5107(24)03188-2. doi: 10.1016/j.gie.2024.05.003. Online ahead of print.

Authors

Affiliations

¹ Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan; Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan. Electronic address: kidaakihiko@yahoo.co.jp.
² Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Japan.
³ Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan; Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan.
⁴ Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
⁵ Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan.
⁶ Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan.

PMID: 38729316
DOI: 10.1016/j.gie.2024.05.003

Abstract

[BACKGROUND AND AIMS]: Endoscopic interventions for bile duct stones (BDS) with benign choledochojejunal anastomotic stenosis (bCJS) are challenging. Therefore, we investigated endoscopic interventions for BDS with bCJS. [METHODS]: Seventeen patients with BDS with bCJS were retrospectively analyzed. Patient characteristics, technical success, adverse events (AEs), and recurrence were evaluated. [RESULTS]: In 17 patients, the median diameters of the bile duct and BDS were both 8 mm. The median number of BDS was 3. The technical success rate was 94% (16/17). Ten patients underwent balloon dilation at the choledochojejunal anastomotic site (CAS), the median diameter of balloon dilation was 10.5 mm, and waist disappearance was achieved in 2. Six patients had fully covered self-expandable metal stents (FCSEMS) with a diameter of 10 mm placed at the CAS. BDS were removed after balloon dilation or FCSEMS removal, and 6 out of 16 patients were treated with a combination of lithotripsy and 5 with peroral direct cholangioscopy (PDCS). Regarding AEs, perforation at the CAS by balloon dilation occurred in 1 patient. The median follow-up was 3701 days. Nine out of 16 patients (56%) had recurrence. The patients treated with combination of PDCS at BDS removal (p=0.022) and waist disappearance at the CAS by balloon dilation (p=0.035) had significantly fewer recurrences. [CONCLUSIONS]: Endoscopic interventions for BDS with bCJS are useful and relatively safe; however, long-term follow-ups showed frequent recurrences. Recurrence was common in patients not treated with the combination of PDCS at BDS removal and those without waist disappearance at the CAS by balloon dilation.

Keywords: balloon dilation; benign choledochojejunal anastomotic stenosis; bile duct stones; fully-covered self-expandable metal stent; peroral direct cholangioscopy.