A new biliary access technique for the long-term endoscopic management of intrahepatic stones.
Intrahepatic stone disease poses a difficult postoperative management problem due to frequent stone recurrence. Most of the methods proposed for long-term access to the intrahepatic biliary tree require multiple sessions of additional, usually invasive, procedures. An alternative method for endoscopic long-term access to the intrahepatic ducts, represented by a side-to-side anastomosis between the isolated Roux-en-Y jejunal limb of the bilioenteric bypass and the duodenum (duodenojejunostomy), was used in eight patients with retained and/or recurrent stones after surgical treatment of intrahepatic stone disease. There were no short- or long-term complications or mortality associated with the duodenojejunostomy. Postoperative endoscopic access to the intrahepatic ducts was successfully achieved in five of six patients: one with stone recurrence, one with a left hepatic duct stricture and stone recurrence and one with known retained postoperative stones. In two patients, no stones were found at endoscopy. Side-to-side duodenojejunostomy may be useful in the long-term endoscopic management of recurrent intrahepatic biliary stone disease and should be indicated whenever a bilioenteric anastomosis is performed for the treatment of bilateral intrahepatic stone disease.
Department of Gastroenterology, Surgical Division, São Paulo University Medical School, São Paulo, Brazil.
José Eduardo
JE
Monteiro Cunha
Paulo
P
Herman
Marcel C C
MC
Machado
Sonia
S
Penteado
Fauze Maluf
FM
Filho
José
J
Jukemura
Telésforo
T
Bacchella
Emílio E
EE
Abdo
D000328:Adult; D000465:Algorithms; D001649:Bile Duct Diseases / Q000503:physiopathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002769:Cholelithiasis / Q000601:surgery* / Q000628:therapy; D003251:Constriction, Pathologic; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004386:Duodenum / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome