title: Choledochoscopic high-frequency needle-knife electrotomy for treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy.
abstract: BACKGROUND
  Anastomotic stricture is a complex and substantial complication following Roux-en-Y hepaticojejunostomy. Initially, endoscopic and percutaneous approaches are often attempted, but the gold standard remains surgical biliary reconstruction, especially for refractory stricture. However, this solution leaves much room for improvement, due to the challenging nature of the biliary reconstruction procedure, in which anastomotic stricture may still occur.
  
  
  OBJECTIVE
  To investigate the feasibility and effectiveness of choledochoscopic high-frequency needle-knife electrotomy as an intervention in the treatment of anastomotic strictures following Roux-en-Y hepaticojejunostomy.
  
  
  METHODS
  From February 2010 to October 2014, clinical data was collected and retrospectively compared for patients who underwent balloon dilation or/and choledochoscopic high-frequency needle-knife electrotomy for the treatment of anastomotic strictures after Roux-en-Y hepaticojejunostomy.
  
  
  RESULTS
  A total of 38 patients underwent successful choledochoscopic treatment and all the anastomotic strictures were removed successfully, 19 of which were treated with electrotomy, 7 with balloon dilation, and 12 with both electrotomy and balloon dilation. Among these groups,the average operating times were 6.9 ± 2.4 min,10.1 ± 6.8 min, and 20.2 ± 13.5 min, respectively. The average stent supporting times were 6.3 ± 0.7 months, 6.5 ± 0.6 months, and 6.1 ± 0.4 respectively. The mean follow-up after stent removal was 42.1 ± 27.4 months, and in 26.3 % (5/19), 28.5 % (2/7) and 16.7 % (2/12) of cases, recurrent anastomotic stricture occurred. Of these 9 total patients with recurrent anastomotic, two patients were successfully rescued by full-covered self-expanding removable metal stents and 7 patients by electrotomy combined with balloon dilation.
  
  
  CONCLUSIONS
  Choledochoscopic high-frequency needle-knife electrotomy is both feasible and safe in the treatment of anastomotic stricture after Roux-en-Y hepaticojejunostomy, with a similar long-term outcome to balloon dilation in treating anastomotic stricture after Roux-en-Y hepaticojejunostomy. A combination of choledochoscopic electrotomy concurrent with balloon dilation should be recommended based on the low rate of recurrence.
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China. yangyulong516@sina.com.
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Yang
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Yue-Feng
authors.initials: YF
authors.lastname: Ma
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Li
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Zhang
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Shi
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Mei-Ju
authors.initials: MJ
authors.lastname: Lin
authors.affiliation: Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, No, 6. Jiefang Road, Zhongshan District, Dalian, Liaoning Province, 116001, P. R. China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery*; D004106:Dilatation / Q000379:methods; D004322:Drainage / Q000379:methods; D004598:Electrosurgery / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000473:pathology* / Q000601:surgery*; D008099:Liver / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Anastomotic stricture; Balloon dilatation; Choledochoscope; Electrotomy; Hepaticojejunostomy