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Clinical outcome of endoscopic treatment of symptomatic Hepaticojejunal anastomotic strictures after pancreatoduodenectomy. | LitMetric

AI Article Synopsis

  • Hepaticojejunostomy anastomotic stricture (HJAS) is a complication following pancreatoduodenectomy, leading to issues like jaundice, which can potentially be managed through endoscopic techniques.
  • A study at Erasmus MC from 2004-2020 included 62 patients with symptomatic HJAS, revealing a high technical success rate in reaching the stricture but a notable 57% recurrence rate within an average of 7.5 months post-intervention.
  • While endoscopic treatment shows promise, adverse events were relatively low at 4%, mainly involving cholangitis, suggesting the need for improved treatment protocols and further comparisons with alternate methods.

Article Abstract

Background: Hepaticojejunostomy anastomotic stricture (HJAS) is an adverse event after pancreatoduodenectomy (PD) which can result in jaundice and/or cholangitis. With endoscopy, HJAS can be managed. However, few studies report the specific success and adverse event rates of endoscopic therapy after PD.

Methods: Patients with symptomatic HJAS, who underwent an endoscopic retrograde cholangiopancreatography at the Erasmus MC between 2004-2020, were retrospectively included. Primary outcomes were short-term clinical success defined as no need for re-intervention <3 months and long-term <12 months. Secondary outcome measures were cannulation success and adverse events. Recurrence was defined as symptoms with radiological/endoscopic confirmation.

Results: A total of 62 patients were included. The hepaticojejunostomy was reached in 49/62 (79%) of the patients, subsequently cannulated in 42/49 (86%) and in 35/42 patients (83%) an intervention was performed. Recurrence of symptomatic HJAS after technically successful intervention occurred in 20 (57%) patients after median time to recurrence of 7.5 months [95%CI, 7.2-NA]. Adverse events were reported in 4% of the procedures (8% of patients), mostly concerning cholangitis.

Discussion: Endoscopic treatment for symptomatic HJAS after PD has a moderate technical success rate and a high recurrence rate. Future studies should optimize endoscopic treatment protocols and compare percutaneous versus endoscopic treatment.

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Source
http://dx.doi.org/10.1016/j.hpb.2023.05.362DOI Listing

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