A novel endoscopic technique using fully covered self-expandable metallic stents for benign strictures after hepaticojejunostomy: the saddle-cross technique (with video).

Abstract

BACKGROUND:

In recent years, the number of patients with hepaticojejunostomy anastomotic strictures has increased. Balloon dilation and placement of multiple plastic stents have proven effective for hepaticojejunostomy anastomotic strictures. However, for refractory strictures, there is often a need for repeated endoscopic procedures within a short period. This study aimed to assess the efficacy and safety of the new saddle-cross technique, which uses two fully covered self-expandable metallic stents.

METHODS:

This was a retrospective analysis of 20 patients with benign hepaticojejunostomy anastomotic strictures who underwent placement of two fully covered self-expandable metallic stents at the National Cancer Center, Japan, from November 2017 to June 2021.

RESULTS:

The technical and clinical success rates were 100% (20/20). The median time of the procedure was 61 (range 25-122) min. The scheduled stent removal rate was 70% (14/20). Spontaneous dislodgement of the stent was observed on computed tomography in five patients (25.0%). The non-restenosis rate 12 months after the saddle-cross technique was 88.2% (15/17). Procedure-related early adverse events included mild ascending cholangitis in three patients (15.0%) and sepsis in one patient (5.0%). Procedure-related late adverse events included mild ascending cholangitis in three patients (15.0%) and bile duct hyperplasia in one patient (5.0%).

CONCLUSIONS:

The saddle-cross technique performed using two fully covered self-expandable metallic stents resulted in promising long-term stricture resolution with a high technical success rate. Based on these findings, the saddle-cross method can be considered an option for the standard procedure for benign hepaticojejunostomy anastomotic strictures.

• Authors: Yuki Kawasaki, Susumu Hijioka, Yosikuni Nagashio, Akihiro Ohba, Yuta Maruki, Kosuke Maehara, Motohiro Yoshinari, Yuya Hisada, Shota Harai, Hidetoshi Kitamura, Yumi Murashima, Takehiko Koga, Shun Kawahara, Syunsuke Kondo, Chigusa Morizane, Hideki Ueno, Jun Ushio, Kiichi Tamada, Shunsuke Sugawara, Miyuki Sone, Takeshi Takamoto, Satoshi Nara, Daisuke Ban, Minoru Esaki, Yasuaki Arai, Kazuaki Shimada, Yutaka Saito, Takuji Okusaka
• Journal: Surgical endoscopy (Surg Endosc) Vol. 36 Issue 12 Pg. 9001-9010 (12 2022) ISSN: 1432-2218 [Electronic] Germany
• PMID: 35817882 (Publication Type: Video-Audio Media, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Humans
• Constriction, Pathologic (etiology, surgery)
• Retrospective Studies
• Treatment Outcome
• Self Expandable Metallic Stents
• Stents (adverse effects)
• Cholangitis (etiology)
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects)