Itsuki Sano1,2, Akio Katanuma1, Masaki Kuwatani2, Hiroshi Kawakami2, Hironari Kato3, Takao Itoi4, Michihiro Ono5, Atsushi Irisawa6, Yoshinobu Okabe7, Takuji Iwashita8, Ichiro Yasuda9, Shomei Ryozawa10, Seiji Kaino11, Naoya Sakamoto2. 1. Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan. 2. Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan. 3. Department of Gastroenterology and Hepatology, Okayama University, Okayama, Japan. 4. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 5. Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan. 6. Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan. 7. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan. 8. First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan. 9. Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan. 10. Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan. 11. Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Abstract
BACKGROUND AND AIM: Data on long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using balloon-assisted enteroscopy (BAE) for choledochojejunal anastomotic stenosis (CJS) or pancreaticojejunal anastomotic stenosis (PJS) remain limited. We retrospectively assessed the long-term results of patients who achieved clinical success using BAE for CJS and PJS. METHODS: Patients who achieved technical and clinical success for CJS or PJS by BAE-ERCP and were followed up for more than 6 months after the initial BAE-ERCP therapy were retrospectively identified at 11 Japanese institutions. The primary end-point was CJS or PJS recurrence rates. The secondary end-points were initial therapy details, initial therapy complications, and CJS or PJS recurrence treatment details. We also evaluated restenosis-associated factors. RESULTS: From September 2008 to December 2015, 67 patients (CJS, 61; PJS, six) were included. The overall CJS and PJS recurrence rates were 34.4% and 33.3%, respectively. The 1-year CJS recurrence rate was 18.5% (95% confidence interval, 10.7-31.0). Of all the patients, 88.1% underwent balloon dilation at the anastomotic stenosis site; stent placement was performed in 15 of 67 patients (22.4%). The complication rate was 8.2% in CJS and 0% in PJS. In patients who underwent balloon dilation, "remaining waist" was significantly associated with CJS recurrence after anastomotic balloon dilation (P = 0.001). CONCLUSIONS: The long-term outcomes of BAE-ERCP were comparable with those of percutaneous transhepatic treatment or surgical re-anastomosis.
BACKGROUND AND AIM: Data on long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using balloon-assisted enteroscopy (BAE) for choledochojejunal anastomotic stenosis (CJS) or pancreaticojejunal anastomotic stenosis (PJS) remain limited. We retrospectively assessed the long-term results of patients who achieved clinical success using BAE for CJS and PJS. METHODS:Patients who achieved technical and clinical success for CJS or PJS by BAE-ERCP and were followed up for more than 6 months after the initial BAE-ERCP therapy were retrospectively identified at 11 Japanese institutions. The primary end-point was CJS or PJS recurrence rates. The secondary end-points were initial therapy details, initial therapy complications, and CJS or PJS recurrence treatment details. We also evaluated restenosis-associated factors. RESULTS: From September 2008 to December 2015, 67 patients (CJS, 61; PJS, six) were included. The overall CJS and PJS recurrence rates were 34.4% and 33.3%, respectively. The 1-year CJS recurrence rate was 18.5% (95% confidence interval, 10.7-31.0). Of all the patients, 88.1% underwent balloon dilation at the anastomotic stenosis site; stent placement was performed in 15 of 67 patients (22.4%). The complication rate was 8.2% in CJS and 0% in PJS. In patients who underwent balloon dilation, "remaining waist" was significantly associated with CJS recurrence after anastomotic balloon dilation (P = 0.001). CONCLUSIONS: The long-term outcomes of BAE-ERCP were comparable with those of percutaneous transhepatic treatment or surgical re-anastomosis.