Utilization of a Modified Roux-en-Y Anastomosis as an Access point for Percutaneous Transjejunal Cholangioplasty of Recurrent Biliary Strictures

Jagteshwar Sandhu, Adam Swersky, Jason Salsamendi, Robert B. Abrahams, Shree Venkat, Danny Sleeman, Prasoon Mohan

Research output: Contribution to journalArticle

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Abstract

Introduction: Biliary duct injuries pose a significant management challenge due to the propensity for recurrent biliary strictures. Development of a modified Roux-en-Y hepaticojejunostomy known as a Hutson–Russell Pouch (HRP) provides a point of entry for repetitive access to the biliary tree. We aim to highlight the effectiveness of using the HRP as an access point for the long-term management of anastomotic and distal biliary strictures, thereby showcasing the value in potential widespread adoption of this modification to a standard surgical procedure. Materials and methods: IRB-approved retrospective study of 36 patients (10 M, 26 F; mean age 55.19 ± 13.94; 15–83) underwent a total of 110 transjejunal cholangiograms. Indications for cholangiogram included cholangitis (n = 38), surveillance (n = 36), and elevated liver enzymes (n = 36). Technical success was defined by the ability to access and intervene in the biliary tree via HRP access. In case of stenosis, the ability to successfully dilate (< 30%) residual stenosis was considered a technically successful procedure. Clinical success was defined by normalization of the liver function tests or resolution of cholangitis. Results: Technical success was achieved in 83/110 (75.45%) of the cases, and clinical success was achieved in 102/110 (98.2%). Transhepatic access was needed in 27/110 (24.5%) of the cases. Interventions performed included balloon cholangioplasty in 104/110 (94.5%), biliary stone removal in 2/110 (1.8%), biliary stent placement in 2/110 (1.8%), and biliary drain placement in 4/110 (3.6%). There were a total of 9/110 complications (8.2%). Conclusion: The HRP was an effective access point in the management of recurrent benign biliary strictures in this cohort.

Original languageEnglish (US)
Pages (from-to)1745-1750
Number of pages6
JournalCardioVascular and Interventional Radiology
Volume42
Issue number12
DOIs
StatePublished - Dec 1 2019

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Keywords

  • Benign biliary strictures
  • Cholangioplasty
  • Hutson–russell pouch
  • Modified Roux-en-Y hepaticojejunostomy
  • Percutaneous transhepatic cholangiogram
  • Transjejunal cholangiogram

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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