Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results. Postoperative bilioenteric anastomotic strictures are encountered in a significant number of patients after primary biliary repair, hepatopancreaticobiliary tumor. access to the bilioenteric anastomosis and thus to the hepatobiliary tree for non- operative management of chronic and recurrent biliary tract.
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Gastrointestinal Intervention ; 6 1: Some maintain the stenting catheter only between balloon dilation procedures, removing it as soon as maximal balloon dilation is achieved. Benign post-operative bile duct strictures. Sign in to save your search Sign in to your personal account.
A History of the Bilioenteric Anastomosis | JAMA Surgery | JAMA Network
Generally some form of medical imaging is then performed demonstrating intrahepatic biliary dilation with identification of a biliary stricture Anastpmosis. Percutaneous biliary interventions are among the most painful minimally invasive procedures that are routinely performed, necessitating expert sedation to maintain patient comfort.
Direct comparison of complication rates is difficult as reporting and classification of complications is quite variable. While the overall paradigm of percutaneous access, balloon dilation, and catheter stenting remains consistent, institutional protocols differ in several technical variables including balloon sizes, inflation techniques, catheter sizing, and overall time course of treatment, amongst others.
We aim to review some of the current techniques used for percutaneous treatment of bilioenteric strictures, examine short and long-term outcomes of the more common protocols, and comment on future directions of the procedure Table 1. D Completion cholangiogram showing resolution of the stricture post stent removal. At our institution the balloon is expanded to its rated pressure in a gradual fashion, with use of a larger anastmoosis balloon or possibly cutting balloon should the current balloon prove insufficient to dilate nilioenterica stricture.
However some operators advocate more frequent exchanges, with some intervals on the order of a few days. Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures. Surgeries involving the creation of bilioenteric anastomoses are performed in patients for a variety of reasons including primary repair of benign biliary strictures, tumor resection, and liver transplantation.
The first report by Molnar and Stockum 9 described a three phase approach to percutaneous dilation of choledochoenterostomy strictures.
This consists of removal of catheter access across the stricture placement of a small caliber external biliary drain. Access and staging The first report by Molnar and Stockum 9 described a three phase approach to percutaneous dilation of choledochoenterostomy strictures.
Percutaneous transhepatic treatment bilioenterjca postoperative bile leaks: For cases in which this option is not successful, surgical approach is indicated. Roux-en-Y hepatojejunostomy was performed.
A history of the bilioenteric anastomosis.
Transhepatic dilation of anastomotic biliary strictures in liver transplant recipients with use of a combined cutting and conventional balloon protocol: Dissolvable stents Dissolvable stents made from polydioxanone Fig.
The trial conducted by Mauri et al 44 demonstrated continued patency at a median follow up time of This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License http: Current protocols for percutaneous treatment of BAS are varied in their technique and success rates.
Long-term outcomes of a benign biliary stricture protocol. At our institution, daily flushing of the catheter with 10 mL of normal saline is used to ensure continued catheter patency.
A History of the Bilioenteric Anastomosis
Before performing percutaneous balloon dilation, a full biochemical laboratory analysis including complete blood count, comprehensive metabolic profile including a liver panel, and a coagulation profile should be obtained.
Should a stricture recur after conclusion of a treatment, it is considered a treatment failure. Some protocols use sequential stricture dilation with catheters, rather than balloon inflation, as the main mechanism of treatment. Register for email alerts bilioenterixa links to free full-text articles Access PDFs of free articles Manage your interests Bilioenterlca searches and receive search alerts.
Factors such as patient acuity, ease of percutaneous access, level of pre-stenotic biliary dilation, severity of stricture, ease of crossing the stricture with a guide wire, and various logistical and economic factors all play a role.
A history of the bilioenteric anastomosis.
Long-term follow-up of percutaneous transhepatic biliary drainage PTBD in patients with benign bilioenterostomy stricture. The stent covering limits potential mucosal ingrowth and hyperplasia, factors which lead to wnastomosis and difficult retrieval in uncovered metallic stents.
Percutaneous intervention for bilioenteric anastomotic strictures: Get free access to newly published articles. Current management of postoperative complications and benign biliary strictures.
Long-term results of metallic stents for benign biliary strictures. The medical charts of patients with biliary complications after OLT during a year periodwho failed to respond to nonsurgical treatment and were surgically treated, were reviewed.
Since this time there has been evolution of tools and technique. First, because of the embedded blades, caution must be taken by the operator when handling the balloon bilienterica outside of the patient.
Certain technical aspects must also be mentioned when using cutting balloons. However, treatment subjects in that study were exclusively post-transplant, confounding a direct comparison.
Stent duration and repeat dilation Once the stent catheter has been placed, it has to be maintained long enough wnastomosis the ballooned stricture has time to heal around it. Benign postoperative biliary strictures: Most protocols for biliary dilation follow the general staged protocol initially described by Molnar and Stockum.
Cutting balloons have become increasingly used in the context of benign biliary strictures, especially when strictures prove refractory to dilation with conventional angioplasty balloons.