Two decades of percutaneous transjejunal biliary intervention for benign biliary disease: a review of the intervention nature and complications

Abstract

Objective To assess outcomes of percutaneous transjejunal biliary intervention (PTJBI) in terms of success and effectiveness in patients with a Roux-en-Y hepaticojejunostomy for benign biliary strictures and stones. Methods Clinical and radiographic records of 63 patients with a Roux-en-Y choledochojejunostomy or hepaticojejunostomy for benign disease who underwent at least one PTJBI between 1986 and 2007 were reviewed. Effectiveness was determined by successful access rate, rates of stricture dilatation and/or stone extraction, morbidity, complications and hospitalisation. Results PTJBI was attempted 494 times. Successful access to the Roux-en-Y was accomplished in 93% of interventions. After access to the Roux-en-Y was granted, all strictures were effectively dilated. Ninety-seven percent of extraction attempts of intrahepatic calculi were successful. The median number of interventions per patient was five. The median interval between interventions was 51.5 weeks (range 2.7-1,279.6 weeks). The early complication rate was 3%. Morbidity, measured in terms of cholangitis episodes was 14%, in 25 out of 63 patients. Mean hospitalisation was 4.1 nights per year. Conclusion PTJBI is safe and effective in treating benign biliary strictures and/or calculi. High success rates and short hospitalisation periods, together with few complications make it a well-accepted and integral part of managing complex biliary problems.

Recanalization for Tight Bile Duct-Jejunum Anastomosis Stricture Using Peroral Transliminal Cholangioscopy (with Video)

“…Traditionally, interventional radiology such as percutaneous transhepatic biliary drainage (PTCD) or surgical re-anastomosis may be the first choice of treatment of this complication. The technical success rate and complication rates of PTCD for biliary stricture in anastomosis site were each 55-95% and 11-35%, and surgical re-anastomosis were each 71-91% and 20-33%, according to previous reports [5][6][7][8]. These results may not be sufficient in clinical practice, and these procedures have several disadvantages such as cosmetic problem or invasiveness.…”

Complex biliary intervention: Percutaneous small bowel access confirmation with cone-beam computed tomography and retrograde biliary obstruction recanalization

“…1 In the largest previously described series, overall procedure-related complication rate of percutaneous transjejunal biliary intervention was 3% including sepsis (most common complication), roux limb perforation, wound infection, portal vein puncture with hemorrhage, and erythematous reaction. 1 In the majority of the described cases, the jejunal access is fixed to the skin with surgical markers placed during the initial surgery. Accessing non-marked loops has been described previously using percutaneous transhepatic cholangiography to opacify the loops 2,7 or previous CT images to identify the loop.…”

“…1 Interventional radiologists still play an important role in these cases as they can access the biliary system percutaneously. Many biliary obstructions can be treated with percutaneous transhepatic biliary drainage (PTBD), but some biliary obstructions are not easily crossed with typical antegrade recanalization.…”

“…Many biliary obstructions can be treated with percutaneous transhepatic biliary drainage (PTBD), but some biliary obstructions are not easily crossed with typical antegrade recanalization. 1 In cases of obstruction with multiple isolated ducts, routine PTBD would require multiple percutaneous drains to effectively drain the biliary system. Some of these cases may be better served by retrograde biliary recanalization after obtaining percutaneous jejunal access.…”

“…The use of a jejunostomy access to perform biliary interventions is an established technique for the treatment of biliary stenosis in patients with HJ anastomosis. [1][2][3][4] Percutaneous small bowel access can be a challenging procedure if the intestinal loop is not fixed to the anterior abdomen with metallic markers usually placed during the initial surgery. 1,2 Fluoroscopic aids in locating a target loop of bowel such as iodinated contrast and air can quickly move out of the bowel, and do not exclude an interposed segment of colon between the percutaneous access site and the target loop of small bowel.…”