Thirty years' experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes.
OBJECTIVE
To determine the effectiveness of percutaneous balloon dilation of benign postoperative biliary strictures.


METHODS
We received approval from our institutional review board to undertake this retrospective HIPAA-compliant study, and informed consent was waived. From April 1, 1977, to April 1, 2007, percutaneous biliary balloon dilation (PBBD) was performed in 85 patients with benign biliary strictures. In the 75 patients with follow-up (31 male, 44 female; mean age, 56 years; mean follow-up, 8 years), 205 PBBD procedures were performed during 112 treatments of 84 biliary strictures. PBBD of the stricture was performed with a noncompliant balloon (8-12-mm diameter). PBBD procedures were repeated at 2- to 14-day intervals until cholangiography demonstrated free drainage of contrast material to the bowel and no residual stenosis. An internal-external biliary drain was left in situ for a mean of 14-22 days and removed after a clinical trial of catheter clamping and a normal cholangiogram.


RESULTS
All procedures were technically successful, and 52, 11, 10, and two patients underwent a total of one, two, three, and four PBBD treatments, respectively. Four of 205 procedures (2%) led to major complications: two subphrenic abscesses, one hepatic arterial pseudoaneurysm, and one case of hematobilia treated with transfusion. Six patients died from unrelated causes and three from hepatitis C-related liver failure. The probability of a patient not developing clinically significant restenosis at 5, 10, 15, 20, and 25 years was 0.52, 0.49, 0.49, 0.41, and 0.41, respectively, after the first PBBD treatment and 0.43, 0.30, 0.20, 0.20, and 0.20, respectively, after the second PBBD treatment. No significant difference was found in the rate of clinically significant restenosis after the first PBBD between strictures at anastomotic and nonanastomotic sites (P = .75). During the follow-up period, 56 of 75 patients (75%) had successful management with PBBD.


CONCLUSIONS
PBBD of benign strictures demonstrates long-term effectiveness. No significant difference was found in the rate of clinically significant restenosis after PBBD of biliary strictures at anastomotic and nonanastomotic sites.
Cantwell
Colin P
CP
Division of Abdominal and Interventional Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass, USA. ccanty@gofree.indigo.ie
Pena
Constantino S
CS
Gervais
Debra A
DA
Hahn
Peter F
PF
Dawson
Steven L
SL
Mueller
Peter R
PR
D017541:Aneurysm, False / Q000209:etiology; D001649:Bile Duct Diseases / Q000473:pathology / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects; D002758:Cholangiography; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006431:Hemobilia / Q000209:etiology; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013369:Subphrenic Abscess / Q000209:etiology; D016896:Treatment Outcome