Use of choledochoscopy to treat anastomotic stricture after cholangiojejunostomy through a preset subcutaneous intestinal loop: a study of 30 cases

OBJECTIVE: This study was performed to summarize our experience in applying choledochofiberscopy to the treatment of anastomotic stricture after cholangiojejunostomy. METHODS: We retrospectively analyzed patients who underwent choledochofiberscopy for the treatment of anastomotic stricture via balloon dilatation and were followed up for at least 6 to 12 months. RESULTS: A 6- to 12-month follow-up was performed in the above-mentioned 30 patients after trans-choledochofiberscopic balloon dilation and stone removal. Among these patients, 19 did not develop recurrent fever or abdominal pain, and the serum levels of direct bilirubin, aspartate aminotransferase, γ-glutamyl transpeptidase, and alkaline phosphatase returned to normal or near normal, with a total success rate of 63%. Eleven patients developed restenosis and recurrence of intrahepatic stones, with a stenosis rate of 37%. Among these 11 patients, 6 underwent trans-choledochofiberscopic balloon dilatation for stone removal, and they recovered uneventfully; the remaining 5 patients were transferred for surgical reoperations for treatment of stenosis following repeated dilatation, with a failure rate of 17%. CONCLUSION: Choledochofiberscopy for the treatment of anastomotic stricture after cholangiojejunostomy has the following advantages: minimal trauma, minimal pain, rapid effect, low risk, repeatable treatment procedures, and no serious complications. This is a safe and effective method of treatment.