Peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures: long-term results.

PURPOSE To report the long-term follow-up results of peripheral cutting balloon incision and dilatation (PCBID) after failed high-pressure balloon dilatation in patients with benign ureteral and biliary strictures. MATERIALS AND METHODS The study included 9 patients (5 males and 4 females) who underwent successful PCBID procedures. Of these, 4 patients had biliary strictures; 2 of them had choledocho-choledochal anastomosis after liver transplantation, one at the choledocho-jejunal anastomosis, and the other at the papilla of Vater after failed endoscopic papillotomy. Of the 5 patients with ureteral strictures, 2 occurred following kidney transplantation, one after local radiation, and 2 had pelvic metastases compressing the urinary tract. The duration of follow-up, both clinical and radiological, was 24 months. RESULTS The 9 patients who underwent successful PCBID procedures represented 82% of the original group treated by PCBID, which we reported in a previous publication. There were no periprocedural complications. The rate of primary patency, which was confirmed clinically and ultrasonographically at the end of follow- up, was 55% (5/9), and the secondary patency rate was 78% (7/9). Choledocho-choledochal restenosis occurred in 2 patients, 5 and 9 months after liver transplantation, who were treated percutaneously; one by balloon angioplasty (secondary patency for 19 months) and the other by PCBID (patency for 15 months). The remaining 2 patients (both with pelvic metastases) had restenosis 5 and 6 months postprocedure and were successfully treated by the insertion of double-J ureteral stents. CONCLUSION PCBID is a simple and safe option for the treatment of ureteral and biliary strictures after failed high-pressure balloon dilatation, which demonstrated a two-year primary patency rate of 55% and a secondary patency rate of 78%.