A new biliary access technique for the long-term endoscopic management of intrahepatic stones

Abstract

Intrahepatic stone disease poses a difficult postoperative management problem due to frequent stone recurrence. Most of the methods proposed for long-term access to the intrahepatic biliary tree require multiple sessions of additional, usually invasive, procedures. An alternative method for endoscopic long-term access to the intrahepatic ducts, represented by a side-to-side anastomosis between the isolated Roux-en-Y jejunal limb of the bilioenteric bypass and the duodenum (duodenojejunostomy), was used in eight patients with retained and/or recurrent stones after surgical treatment of intrahepatic stone disease. There were no short- or long-term complications or mortality associated with the duodenojejunostomy. Postoperative endoscopic access to the intrahepatic ducts was successfully achieved in five of six patients: one with stone recurrence, one with a left hepatic duct stricture and stone recurrence and one with known retained postoperative stones. In two patients, no stones were found at endoscopy. Side-to-side duodenojejunostomy may be useful in the long-term endoscopic management of recurrent intrahepatic biliary stone disease and should be indicated whenever a bilioenteric anastomosis is performed for the treatment of bilateral intrahepatic stone disease.

An immunohistochemical study of osteopontin in hepatolithiasis

“…Several methods for the management of hepatolithiasis have been reported . However, obtaining a complete cure of hepatolithiasis is very difficult.…”

Management of adult choledochal cysts – a 15-year experience

“…However, when either a part or whole of the intrahepatic component remains, an access loop of the jejunum created with the Roux Y limb would provide an easy route for removal of intrahepatic calculi, biliary sludge or debris either endoscopically or radiologically. The access loop can be either placed subcutaneously or fashioned as duodenojejunal anastomosis 7, 29, 30 . In two cases, in addition to hepaticojejunostomy, a cholangiojejunostomy between the dilated intrahepatic biliary radicles and the Roux Y limb was performed.…”

Non‐Oriental Primary Intrahepatic Lithiasis: Experience with 48 Cases

“…These techniques include cutaneous hepaticojejunostomy, where the jejunal loop of the bilioenteric anastomosis is located in the subcutaneous tissue on the abdominal wall to allows a future endoscopic approach with a small skin incision [32]. Another technique was proposed by our group: construction of a laterolateral anastomosis between the jejunal loop of the hepaticojejunostomy and the duodenum to allow a future endoscopic approach [33]. For the treatment of recurrence, the transhepatic percutaneous approach has also been employed, with good results.…”