title: Percutaneous management of resistant biliary-enteric anastomotic strictures with the use of a combined cutting and conventional balloon cholangioplasty protocol: a single-center experience.
abstract: OBJECTIVE
  To evaluate the safety and technical efficacy of percutaneous transhepatic dilation of resistant biliary-enteric anastomotic strictures using a combination of cutting and conventional balloons and evaluate midterm results.
  
  
  METHODS
  A retrospective review of patients with biliary-enteric anastomotic strictures treated with percutaneous transhepatic cutting balloon dilation was performed. Cutting balloon dilation was followed by dilation with the use of a conventional balloon with a diameter larger than that of the cutting balloon. Technical success was defined by the composite criteria of fluent passage of manually injected contrast medium through the anastomoses into the small bowel and absence of bile duct dilatation compared with the cholangiogram obtained before the procedure. Clinical and laboratory parameters, including serum bilirubin, alkaline phosphatase, and total leukocyte counts, were monitored in all patients at regular intervals after a technically successful procedure.
  
  
  RESULTS
  Between January 2012 and September 2013, eight patients (three men and five women) with a mean age of 50 years (range, 32-75 y) underwent 11 sessions of combined cutting and conventional balloon cholangioplasty. The procedure was technically successful in all patients. There were no major complications during the procedure. During the follow-up period (mean, 14 mo; range, 8-24 mo), all patients remained free of any biliary obstructive symptoms and had normal laboratory parameters with the absence of biliary dilatation on ultrasound examinations.
  
  
  CONCLUSIONS
  Cutting balloon dilation is a safe adjunctive option for the treatment of biliary-enteric anastomotic strictures resistant to conventional balloon dilation with acceptable midterm patency rates.
authors: Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India.
authors: Amar
authors: A
authors: Mukund
authors: Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India. Electronic address: rajesh387@gmail.com.
authors: S
authors: S
authors: Rajesh
authors: Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India.
authors: Nitesh
authors: N
authors: Agrawal
authors: Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India.
authors: Asit
authors: A
authors: Arora
authors: Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi 110070, India.
authors: Ankur
authors: A
authors: Arora
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome