title: Double-balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato-biliary-pancreatic operation.
abstract: OBJECTIVE
  There have been few reports on the success rate of balloon dilation and stent deployment using endoscopic retrograde cholangiopancreatography by double-balloon enteroscopy (DBE-ERCP) or on the follow-up period after stent removal in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis. The present study was designed to evaluate the usefulness of DBE-ERCP in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis.
  
  
  METHODS
  Forty-four patients with stenosis of choledochojejunal anastomosis underwent DBE-ERCP at Okayama University Hospital between April 2008 and January 2012 (107 procedures). Rates of reaching choledochojejunal anastomosis, stent deployment, and restenosis after stent removal were retrospectively evaluated.
  
  
  RESULTS
  Insertion of DBE into the choledochojejunal anastomotic site succeeded in 38 of 44 patients (86.4%), and anastomotic dilation and stent deployment succeeded in 36 of 44 patients (81.8%). In 32 of 44 patients (72.7%), their anastomotic stenoses were improved, and they achieved stent removal. After stent removal, restenosis of choledochojejunal anastomosis was detected in seven of 32 patients; however, the resolution of restenosis was achieved in all seven of those patients.
  
  
  CONCLUSIONS
  Dilation of choledochojejunal anastomosis combined with stent deployment using DBE-ERCP seems to be a viable first-line treatment for patients with stenosis of choledochojejunal anastomosis.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sakakihara
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Muro
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Noma
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Harada
authors.forename: Shigeru
authors.initials: S
authors.lastname: Horiguchi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sadamori
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003135:Common Bile Duct / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D058582:Double-Balloon Enteroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: choledochojejunal anastomotic stenosis; dilation; double-balloon enteroscopy (DBE); endoscopic biliary stenting; endoscopic retrograde cholangiopancreatography (ERCP)