Therapeutic transjejunal endoscopy for the treatment of biliary complications after choledochojejunostomy

Liu,Guo‑Ping; Zhu,Wen‑Xi; Cheng,Guang‑Ming; Ma,Shu‑Ren

doi:10.3892/etm.2012.815

Therapeutic transjejunal endoscopy for the treatment of biliary complications after choledochojejunostomy

Authors:
- Guo‑Ping Liu
- Wen‑Xi Zhu
- Guang‑Ming Cheng
- Shu‑Ren Ma
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Affiliations: Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China, Faculty of Nursing, Advanced Professional Technology College of China Medical University, Shenyang 110011, P.R. China, Department of Hepatobiliary Surgery, Shenyang North Hospital, Shenyang 110015, P.R. China, Department of Endoscopy, Shenyang North Hospital, Shenyang 110015, P.R. China
Published online on: November 19, 2012 https://doi.org/10.3892/etm.2012.815
Pages: 499-502

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Abstract

The present study aimed to assess the value of endoscopic jejunostomy for post‑biliary intestinal anastomosis biliary complications. The clinical data of the endoscopic therapies by jejunal approach for post‑biliary intestinal anastomosis biliary complications in 13 patients (16 surgeries in total) were retrospectively analyzed. The surgical success rate was 100% (16/16). Nasobiliary tube detention was performed for 2 patients, plastic stent placement for 5 and biliary metal stent placement for 4. The remaining two patients did not retain any drainage tube or bracket after surgery. The incidence rate of intraoperative anastomotic stenostomia was 76.9% (10/13). A noticeable postoperative decrease in bilirubin levels was observed in 10 patients. The level of gallstone‑free patients was 75% (3/4). There were 10 cases in which cholangitis remission or no attack was identified. Post‑operative incisional infection occurred in 3 patients, hepatophyma in 1 and an intestinal fistula in 1. Endoscopic therapy by jejunal approach for post‑biliary intestinal anastomosis biliary complications has the virtue of being safe, effective and minimally invasive. It has extensive potential applications in clinical practice.

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1.	House MG, Cameron JL, Schulick RD, et al: Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg. 243:571–578; discussion. 576–578. 2006. View Article : Google Scholar : PubMed/NCBI
2.	Carrel T, Matthews J, Schweizer W, Baer H, Gertsch P and Blumgart LH: Diagnosis, etiology and treatment of cholangitis following bilio-digestive surgery. Helv Chir Acta. 56:891–896. 1990.(In French).
3.	Matthews JB, Baer HU, Schweizer WP, Gertsch P, Carrel T and Blumgart LH: Recurrent cholangitis with and without anastomotic stricture after biliary-enteric bypass. Arch Surg. 128:269–272. 1993. View Article : Google Scholar : PubMed/NCBI
4.	De Moor V, El Nakadi I, Jeanmart J, Gelin M and Donckier V: Cholangitis caused by Roux-en-Y hepaticojejunostomy obstruction by a biliary stone after liver transplantation. Transplantation. 75:416–418. 2003.PubMed/NCBI
5.	Lasnier C, Kohneh-Shahri N and Paineau J: Biliary-enteric anastomosis malfunction: retrospective study of 20 surgical cases. Review of literature. Ann Chir. 130:566–572. 2005.(In French).
6.	Frilling A, Li J, Weber F, et al: Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience. J Gastrointest Surg. 8:679–685. 2004. View Article : Google Scholar : PubMed/NCBI
7.	Johnson CP, Sarna SK, Cowles VE, et al: Motor activity and transit in the autonomically denervated jejunum. Am J Surg. 167:80–88. 1994. View Article : Google Scholar : PubMed/NCBI
8.	Yamamoto T, Hamanaka Y and Suzuki T: Bile acids and micro-organisms in the jejunal lumen after biliary reconstruction in dogs. J Am Coll Surg. 181:525–529. 1995.PubMed/NCBI
9.	Chuang JH, Lee SY, Chen WJ, Hsieh CS, Chang NK and Lo SK: Changes in bacterial concentration in the liver correlate with that in the hepaticojejunostomy after bile duct reconstruction: implication in the pathogenesis of postoperative cholangitis. World J Surg. 25:1512–1518. 2001. View Article : Google Scholar
10.	Zorn GL III, Wright JK, Pinson CW, Debelak JP and Chapman WC: Antiperistaltic Roux-en-Y biliary-enteric bypass after bile duct injury: a technical error in reconstruction. Am Surg. 65:581–585. 1999.PubMed/NCBI
11.	Pohl J, May A, Aschmoneit I and Ell C: Double-balloon endoscopy for retrograde cholangiography in patients with choledochojejunostomy and Roux-en-Y reconstruction. Z Gastroenterol. 47:215–219. 2009. View Article : Google Scholar : PubMed/NCBI
12.	Köcher M, Cerná M, Havlik R, Král V, Gryga A and Duda M: Percutaneous treatment of benign bile duct strictures. Eur J Radiol. 62:170–174. 2007.
13.	Lorenz JM, Denison G, Funaki B, Leef JA, Van Ha T and Rosenblum JD: Balloon dilatation of biliary-enteric strictures in children. AJR Am J Roentgenol. 184:151–155. 2005. View Article : Google Scholar : PubMed/NCBI
14.	Jan YY, Chen MF and Hung CF: Balloon dilatation of intrahepatic duct and biliary-enteric anastomosis strictures. Long term results Int Surg. 79:103–105. 1994.PubMed/NCBI
15.	Tocchi A, Costa G, Lepre L, Liotta G, Mazzoni G and Sita A: The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. Ann Surg. 224:162–167. 1996. View Article : Google Scholar : PubMed/NCBI
16.	Zafar SN, Khan MR, Raza R, et al: Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis. BMC Surg. 11:192011. View Article : Google Scholar : PubMed/NCBI
17.	Laasch HU and Martin DF: Management of benign biliary stictures. Cardiovasc Intervent Radiol. 25:457–466. 2002. View Article : Google Scholar : PubMed/NCBI
18.	Gott PE, Tieva MH, Barcia PJ and Laberge JM: Biliary access procedure in the management of oriental cholangiohepatitis. Am Surg. 62:930–934. 1996.PubMed/NCBI
19.	Berkmen T, Echenique A and Russell E: Ultrasound guidance in accessing the afferent limb of a modified Roux-en-Y choledochojejunostomy for percutaneous dilation of biliary strictures. J Vasc Interv Radiol. 12:1219–1222. 2001. View Article : Google Scholar : PubMed/NCBI
20.	Perry LJ, Stokes KR, Lewis WD, Jenkins RL and Clouse ME: Biliary intervention by means of percutaneous puncture of the antecolic jejunal loop. Radiology. 195:163–167. 1995. View Article : Google Scholar : PubMed/NCBI
21.	Hutson DG, Russell E, Yrizarry J, et al: Percutaneous dilatation of biliary strictures through the afferent limb of a modified Roux-en-Y choledochojejunostomy or hepaticojejunostomy. Am J Surg. 175:108–113. 1998. View Article : Google Scholar : PubMed/NCBI