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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The benefits of paclitaxel-coated stents are well established in treating vascular stenosis. Most of the recent series conducting balloon dilations are able to effectively treat patients using moderate sedation with intravenous midazolam and fentanyl as for most interventional procedures. This catheter is then capped and the patient monitored over a time course of a few weeks to a few months.

Other Sections Abstract Introduction Diagnosis Percutaneous Dilation Procedural Variables Complications Treatment Success and Failure Peri-Procedural Management and Longitudinal Follow-up Emerging Techniques and Future Directions Conclusion Figures Tables References Introduction 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.

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A History of the Bilioenteric Anastomosis | JAMA Surgery | JAMA Network

Only one patient died of causes not related to bile duct reconstruction during follow-up. N Engl J Med. Should the patient remain asymptomatic for the treatment period, the catheter can be removed, either in clinic or after a final follow-up cholangiogram. A single treatment consists of one or multiple dilation sessions separated by intervals of catheter stenting. Many advances in preoperative and postoperative care have contributed to the low morbidity and mortality of current reconstructive biliary tract surgery.


However the use of large bore stent catheters have shown better success overall than small bore catheters. Benign postoperative biliary strictures: Endoscopic literature agrees that there is no benefit from stenting beyond 1 year. Intrahepatic hepatojejunostomy with partial resection of segments IV and V offers an excellent therapeutic alternative for biliary complications that require a surgical approach after OLT.

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. Direct comparison of complication rates is difficult as reporting and classification of complications is quite variable.

Long-term outcome of percutaneous transhepatic therapy for benign bilioenteric anastomotic strictures. Privacy Policy Terms of Use. At our institution, we have found success with balloon dilation and catheter upsizing every 1—2 months, with no response after 4—5 dilations or 1 year considered a failure. Percutaneous management of postoperative anastomotic biliary strictures. Efficacy of a metallic stent covered with a paclitaxel-incorporated membrane versus a covered metal stent for malignant biliary obstruction: Proponents of stenting with large caliber 16—18 F catheters argue that the insertion of the large caliber catheter is more important to treatment than balloon dilation.

To date, no specific procedural factor has been associated with a significant increase or decrease in complication rate.

A history of the bilioenteric anastomosis.

Create a personal account to register for email alerts with links to free full-text articles. Due to difficulties with repeat surgery and endoscopic access, percutaneous dilation naastomosis become the accepted treatment in these cases.

Most protocols for biliary dilation follow the general staged protocol initially described by Molnar and Stockum.

Long-term outcomes of a benign biliary stricture protocol. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement.


Staging the procedure allows maturation of the percutaneous transhepatic tract. Stent duration and repeat dilation Once the stent catheter has been placed, it has to be maintained long enough that the ballooned stricture anastomossi time to heal around it.

Current strategies and future directions.

Access and staging The first report by Molnar and Stockum 9 described a three phase approach to percutaneous dilation of choledochoenterostomy strictures. Benign post-operative bile duct strictures. Transhepatic dilatation of choledochoenterostomy strictures. This risk can be minimized by ensuring the diameter of the cutting balloon does not exceed the estimated normal diameter of the duct, reserving over-dilation for the conventional balloon.

Illustration of three phase balloon dilation technique originally described by Molnar and Stockum Radiology. Current protocols for percutaneous treatment of BAS are varied in their technique and success rates.

The stent covering limits potential mucosal ingrowth and hyperplasia, anastomoiss which lead to occlusion and difficult retrieval in uncovered metallic stents. Balloon dilation was performed when an optimal size catheter could not be placed.

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. However some operators advocate more frequent exchanges, with some intervals on the order of a few days. Through the percutaneous access, a guidewire is advanced through the stent into the bowel where it is then grasped by the endoscope. Many types of biliary stents have also been developed, although their exact role remains controversial.