Efficacy and Safety of a 6-Month Placement of a Fully Covered Self-Expanding Metal Stent for Refractory or Recurrent Hepaticojejunostomy Anastomotic Stricture via Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography

Abstract

Objectives

Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-assisted ERCP) is performed for hepaticojejunostomy anastomotic stricture (HJAS) after biliary-enteric anastomosis. Although endoscopic balloon dilation (EBD) and plastic stent (PS) placement are commonly performed, they result in high recurrence rates. Studies have demonstrated the efficacy of fully covered self-expanding metal stents (FCSEMS) in HJAS management; however, none have systematically evaluated the outcomes of 6-month placement. Therefore, this retrospective study aimed to evaluate the efficacy and safety of a 6-month FCSEMS placement for benign refractory or recurrent HJAS.

Methods

We evaluated patients who underwent initial treatment with EBD alone or EBD plus PS placement via BE-assisted ERCP between April 2015 and March 2024. Among them, patients with refractory or recurrent HJAS received 6-month FCSEMS placements. The study outcomes were HJAS resolution, adverse events (AEs), and recurrence rates.

Results

Among 92 patients who underwent initial EBD alone or EBD with PS placement, the HJAS resolution rate was 90.2%. The median follow-up period after the initial treatment was 16.1 months, with recurrence observed in 48.2% of patients. Among the 34 patients with refractory or recurrent HJAS, FCSEMS placement achieved a resolution rate of 97.1% in a median of 182 days. AEs occurred in 14.7% of patients (moderate, n = 3; mild, n = 2) following FCSEMS placement. During a median follow-up of 30.9 months, no recurrence was observed after HJAS resolution using FCSEMS.

Conclusions

The 6-month FCSEMS placement for refractory or recurrent HJAS showed high efficacy and safety, indicating its potential as a preferred treatment option.