title: Modern enteroscopic interventions and characterization of nonmalignant postsurgical biliary anastomosis by double-balloon endoscopy.
abstract: BACKGROUND
  Endoscopic access to strictured biliodigestive anastomoses often is difficult and may require percutaneous transhepatic biliary drainage or reoperation.
  
  
  METHODS
  Push- or push-and-pull enteroscopy was used to diagnose disease and treat 24 postsurgical patients with suspected strictured biliodigestive anastomosis. Endoscopic retrograde cholangiography and biliary interventional procedures were used. Endoscopic accessibility, diagnosis of disease, therapeutic success, and complication rates were investigated at a single tertiary university gastroenterology center.
  
  
  RESULTS
  Push enteroscopy reached biliary enteroanastomoses in 5 of the 24 patients (20.8%), whereas push-and-pull enteroscopy found choledocho- or hepaticojejunostomies in 17 of the remaining 19 postsurgical patients (89.4%). In all, successful enteroscopic intervention was achieved for 21 of the 24 patients (87.5%), whereas only 3 patients had to undergo percutaneous cholangiodrainage (12.5%). Cicatricially changed biliodigestive anastomoses were found in 14 of 21 patients (66.6%) including a mucosal type stricture in 7 patients (50%), an intramural type stricture in 5 patients (35.7%), and a ductal type stricture in 2 patients (14.2%). The remaining seven patients (33.3%) were normal. Enteroscopic interventions at strictured biliodigestive anastomosis included ostium incision for 8 (57.1%) and endoprosthesis insertion for 13 (92.8%) of the 14 patients, with prompt resolution of cholestasis and cholangitis. The major complications for the 24 patients involving 68 double-balloon enteroscopy (DBE) examinations comprised 2 perforations (8.3% per patient), 1 mild peritonitis (4.1%), and 1 cholangitis (4.1%), whereas minor complications were experienced by up to 20.8% of the patients.
  
  
  CONCLUSIONS
  Modern interventional enteroscopy yields a high rate of successful interventions for strictured biliodigestive anastomosis, requires ostium incision for mucosal and intramural types of strictures, and helps to reduce percutaneous approaches.
authors.affiliation: Department of Medicine I, Gastroenterology, Endoscopy, University of Erlangen, Erlangen, Germany. martin.raithel@uk-erlangen.de
authors.forename: M
authors.initials: M
authors.lastname: Raithel
authors.forename: A
authors.initials: A
authors.lastname: Naegel
authors.forename: H
authors.initials: H
authors.lastname: Dormann
authors.forename: Th
authors.initials: T
authors.lastname: deRossi
authors.forename: H
authors.initials: H
authors.lastname: Diebel
authors.forename: S
authors.initials: S
authors.lastname: Raithel
authors.forename: F
authors.initials: F
authors.lastname: Krauss
authors.forename: E G
authors.initials: EG
authors.lastname: Hahn
authors.forename: J
authors.initials: J
authors.lastname: Maiss
mesh_terms: D000714:Anastomosis, Surgical; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D003251:Constriction, Pathologic / Q000601:surgery; D058582:Double-Balloon Enteroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*