The use of double balloon enteroscopy for diagnosis and treatment of strictures of hepaticojejunal anastomoses after primary correction of bile duct injuries

INTRODUCTION Development of strictures of hepaticojejunal anastomoses (HJA) is observed in 6-30% of patients and mortality after repeated reconstructive interventions ranges from 13% to 25%. Double balloon enteroscopy (DBE) allows one to visualize the zone of Roux-en-Y anastomosis after reconstructive operations on the bile ducts for differentiation between stricture of HJA and recurrent cholangitis. AIM Report on the first experience of DBE of jejunal loop studies after reconstructive operations on the biliary tract. MATERIAL AND METHODS During the period 2002-2012 we performed in our centre 86 hepaticojejunostomies after iatrogenic bile duct injuries. Mean age was 51 ±6 years. Patients with Roux-en-Y HJA and jejunum loop with Braun's bypass anastomosis who underwent DBE with endoscopic retrograde cholangiography (DBE-RChG) in our unit between February 2009 and December 2012 were enrolled in this study. A total of 33 procedures were performed during this period. All of them involved examination of HJA through a jejunum loop by DBE with capture of bile for bacteriology, Roux loop wall for biopsy and miniinvasive procedures. RESULTS The DBE-RChG after visualization of the HJA zone was performed in 21 cases: 3 of them had the jejunum loop to Braun's bypass, 18 - HJA on the Roux loop. In 13 cases stricture of HJA was confirmed: at 6 reoperations were performed, in 7 - miniinvasive procedures (3 - laser vaporizations, 2 - stone extraction, 1 - lithotripsy, 1 - at the first stage stone extraction was carried out, then laser vaporization). The DBE-RChG was performed in 13 (61.9%) patients. The overall diagnostic success with Braun's bypass was 100%, after Roux-en-Y reconstruction in 10 of 13 cases (55.6%). In connection with accumulation of experience, in 2012 diagnostic success in DBE-RChG of HJA on Roux loop increased to 81.3%. CONCLUSIONS The MRI-ChG in our series frequently (10.3%) shows a false-positive result in favor of HJA strictures. The DBE examination of HJA with additional cholangiography is a modern and precise method of detection of HJA strictures. Their DBE-balloon dilation and argon-laser vaporization or DBE lithoextraction are new ways of miniinvasive treatment.