జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

Biliary and Pancreatic Stricturoplasty for Recurrent Stricture after Hepaticojejunostomy and Pancreaticojejunostomy

Justin Muste, Sisi Lu, Ankesh Nigam

Purpose: To evaluate the safety and success of a novel biliary and pancreatic stricturoplasty (BPS) technique in relieving resistant biliary-enteric anastomotic stricture.

Materials and Methods: A retrospective review of patients with hepaticojejunal stricture (HJS) and/or pancreaticojejunal stricture (PJS) treated with the novel technique was performed. Strictures were approached through enterotomy, manually divided, and marsupialized in a manner similar to transdoudenal sphincteroplasty for Sphincter of Oddi Dysfunction. Success was defined by: no increased risk of life-threatening complications, no evidence of restricturing or evidence of complications attributable to restricturing on long-term follow-up. Clinical, radiologic, and laboratory parameters were reviewed in all patients until last clinical encounter.

Results: Seven patients with a mean age of 49.7 ± 12 years underwent eight BPS procedures at Albany Medical Center between 2008 and 2018 after failing previous non-operative approaches when possible. A single episode of cholangitis was noted on short term follow up of HJS stricture, but no long-term complications were noted. Pancreatitis recurred in two PJS patients during long term follow up, but no short-term complications were noted. These complications could not be attributed to recurring stricture or procedure failure.

Conclusion: The BPS technique offers a safe alternative to repeat hepaticojejunostomy or pancreatojejunostomy for resistant biliary-enteric stricture.