Long-term results of oversized balloon dilation for benign anastomotic biliary strictures: initial two-center experience

Abstract Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication—a small dehiscence of the anastomosis—which extended the catheter dwell time. Minor complications occurred in two cases—one small perihepatic hematoma and one segmental thrombosis of the left portal branch—neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.

摘要 研究目的：旨在采用吻合口胆道狭窄（anastomotic biliary stricture, ABS）超大球囊扩张单一步骤术式行经皮肝穿刺胆道扩张，治疗肝胆外科术后良性吻合口胆道狭窄，描述该方案的可行性并量化其长期通畅效果。材料与方法：本研究为回顾性双中心研究，纳入16例连续入组的有症状良性胆肠吻合口狭窄病例。先通过计算机断层扫描（computed tomography, CT）或磁共振成像（magnetic resonance imaging, MRI）评估胆管直径，随后采用比胆管直径大40%~50%的超大球囊扩张狭窄部位，并留置外置胆肠引流管。拔除引流管后，每3个月评估临床症状及实验室检查结果；分别于术后30天、6个月及12个月行随访磁共振成像及计算机断层扫描检查。结果：平均随访时间为31.8±8.15个月。经卡普兰-迈耶（Kaplan-Meier）法估计，1年、2年及3年通畅率分别为88.2%、82.4%及82.4%。共发生1例严重并发症：吻合口小裂开，导致导管留置时间延长；另发生2例轻微并发症：1例为肝周小血肿，1例为左门静脉分支节段性血栓形成，均无需进一步干预。结论：单一步骤ABS超大球囊扩张术治疗良性胆肠吻合口狭窄具有可行性，该术式可获得较高的长期临床成功率与通畅率。