Peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures: long-term results.
OBJECTIVE
To report the long-term follow-up results of peripheral cutting balloon incision and dilatation (PCBID) after failed high-pressure balloon dilatation in patients with benign ureteral and biliary strictures.


METHODS
The study included 9 patients (5 males and 4 females) who underwent successful PCBID procedures. Of these, 4 patients had biliary strictures; 2 of them had choledocho-choledochal anastomosis after liver transplantation, one at the choledocho-jejunal anastomosis, and the other at the papilla of Vater after failed endoscopic papillotomy. Of the 5 patients with ureteral strictures, 2 occurred following kidney transplantation, one after local radiation, and 2 had pelvic metastases compressing the urinary tract. The duration of follow-up, both clinical and radiological, was 24 months.


RESULTS
The 9 patients who underwent successful PCBID procedures represented 82% of the original group treated by PCBID, which we reported in a previous publication. There were no periprocedural complications. The rate of primary patency, which was confirmed clinically and ultrasonographically at the end of follow- up, was 55% (5/9), and the secondary patency rate was 78% (7/9). Choledocho-choledochal restenosis occurred in 2 patients, 5 and 9 months after liver transplantation, who were treated percutaneously; one by balloon angioplasty (secondary patency for 19 months) and the other by PCBID (patency for 15 months). The remaining 2 patients (both with pelvic metastases) had restenosis 5 and 6 months postprocedure and were successfully treated by the insertion of double-J ureteral stents.


CONCLUSIONS
PCBID is a simple and safe option for the treatment of ureteral and biliary strictures after failed high-pressure balloon dilatation, which demonstrated a two-year primary patency rate of 55% and a secondary patency rate of 78%.
Atar
Eli
E
Department of Radiology, Rabin Medical Center Affiliated to the Sacker Faculty of Medicine, Tel Aviv University, Petah Tiqwa, Israel. atareli@hotmail.com
Bachar
Gil N
GN
Eitan
Mor
M
Graif
Franklyn
F
Neyman
Haim
H
Belenky
Alexander
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001660:Biliary Tract Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D003251:Constriction, Pathologic / Q000209:etiology / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology / Q000473:pathology / Q000628:therapy*