Thirty Years' Experience with Balloon Dilation of Benign Postoperative Biliary Strictures: Long-term Outcomes

Cantwell, Colin P.; Peña, Constantino; Gervais, Debra A.; Hahn, Peter F.; Dawson, Steven L.; Müeller, Peter R.

doi:10.1148/radiol.2491080050

Cited by 85 publications

(49 citation statements)

References 17 publications

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“…Benign biliary strictures have been shown to respond well to percutaneous balloon dilatation ( Figure 8). 7 Malignant biliary strictures can be treated with palliative metal stenting. Rarely, biliary obstruction can result in bile leak and biloma formation.…”

mentioning

confidence: 99%

Pancreaticoduodenectomy: expected post-operative anatomy and complications

McEvoy¹,

Lavelle²,

Hoare³

et al. 2014

BJR

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Pancreaticoduodenectomy is a complex, high-risk surgical procedure performed for tumours of the pancreatic head and other periampullary structures. The rate of perioperative mortality has decreased in the past number of years but perioperative morbidity remains high. This pictorial review illustrates expected findings in early and late post-operative periods, including mimickers of pathology. It aims to familiarize radiologists with the imaging appearances of common and unusual post-operative complications. These are classified into early non-vascular complications such as delayed gastric emptying, post-operative collections, pancreatic fistulae and bilomas; late non-vascular complications, for example, biliary strictures and hepatic abscesses; and vascular complications including haemorrhage and ischaemia. Options for minimally invasive image-guided management of vascular and non-vascular complications are discussed. Familiarity with normal anatomic findings is essential in order to distinguish expected post-operative change from surgical complications or recurrent disease. This review summarizes the normal and abnormal radiological findings following pancreaticoduodenectomy.Pancreaticoduodenectomy was first performed in 1909 and was popularized by the American surgeon Allen Whipple, who refined the technique in the 1930s. Indications for the procedure include pancreatic head tumours, periampullary tumours, distal common bile duct tumours and chronic pancreatitis involving the pancreatic head. The mortality rate of the procedure has decreased from .20% to ,2% in high volume centres, making it a more attractive option now than it previously was. 1 However, perioperative morbidity rates remain high (30-40%). Many patients require post-operative imaging and radiologic intervention. Timely recognition of complications is important. EXPECTED POST-OPERATIVE FINDINGS AND MIMICKERS OF PATHOLOGYUnderstanding the surgical procedure and the expected postoperative findings is essential when interpreting imaging. The components of a standard pancreaticoduodenectomy are distal gastrectomy, duodenectomy, partial pancreatectomy, partial choledochectomy, cholecystectomy and proximal jejunectomy. A jejunal loop is mobilized up to the right upper quadrant and three anastomoses are formed: gastrojejunostomy, hepaticojejunostomy and pancreaticojejunostomy (Figure 1). Distal gastrectomy facilitates resection of nodes along the greater and lesser curves of the stomach, reduces delayed gastric emptying and theoretically reduces the risk of gastritis post-operatively.Pylorus-preserving pancreaticoduodenectomy, first described in 1944, 2 has gained popularity in the past two decades. It involves preservation of the stomach and proximal duodenum and formation of a duodenojejunostomy (Figure 1). There is debate in the literature regarding the advantage of pylorus-preserving pancreaticoduodenectomy compared with standard pancreaticoduodenectomy. Preservation of the distal stomach results in reduced frequency of dumping syndrome and...

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mentioning

confidence: 99%

Pancreaticoduodenectomy: expected post-operative anatomy and complications

McEvoy¹,

Lavelle²,

Hoare³

et al. 2014

BJR

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“…However some operators advocate more frequent exchanges, with some intervals on the order of a few days. 19 Bonnel and Fingerhut 2 speculate that the greater success rate observed in their study (treatment failure rate of 15%) compared to other recent series may be due to their choice of a relatively shorter interval between exchanges/dilations of 1.5 months. It has also been speculated that longer time intervals between balloon dilations may result in more focal fibrosis at the stricture site due to interval healing.…”

Section: Stent Duration and Repeat Dilationmentioning

confidence: 66%

“…2,14,15 Several of the large series evaluating percutaneous dilation over the last decade however routinely conduct their first balloon dilations on the initial day of access. [16][17][18][19] The study by Choo et al 15 used the longest delay of 4-6 weeks between access and initial dilation, though did not have a significantly lower complication rate. However, treatment subjects in that study were exclusively post-transplant, confounding a direct comparison.…”

Section: Access and Stagingmentioning

confidence: 99%

“…15,[21][22][23] In his initial description, Molnar and Stockum 9 inflated their balloons for approximately 1-3 minutes, which remains the most commonly used inflation time today. 9,12,16,19,20 There has been no documented difference in outcome between short and long dilation times, and several institutions do not specify a specific time on their protocols. Of the largest studies in the past decade, the shortest inflation time of 10-30 seconds was associated with a treatment failure rate of 17%, 15 while the longest inflation time of 3 minutes was associated with a treatment failure rate of …”

Section: Balloon Inflation Durationmentioning

confidence: 99%

“…Proponents of short-term stenting (up to one month) argue equivalent efficacy with less inconvenience to the patient. 10,19 The trial conducted by Cantwell et al 19 used the shortest treatment duration (mean, 1.1 months), and observed the largest treatment failure rate of 44%. Some maintain the stenting catheter only between balloon dilation procedures, removing it as soon as maximal balloon dilation is achieved.…”

Section: Stent Duration and Repeat Dilationmentioning

confidence: 99%

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Percutaneous intervention for bilioenteric anastomotic strictures: Current strategies and future directions

Hai

Kuban

2017

Int J Gastrointest Interv

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Postoperative bilioenteric anastomotic strictures are encountered in a significant number of patients after primary biliary repair, hepatopancreaticobiliary tumor resection, and liver transplantation. Due to difficulties with repeat surgery and endoscopic access, percutaneous dilation has become the accepted treatment in these cases. 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. The current review aims to discuss various treatment protocols and their relative efficacy, as well as touch on emerging techniques.

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