Long-term Outcomes of Percutaneous Cholangioscope-Assisted Laser Incision for Treatment of Severe Benign Biliary Stenosis

Wednesday, April 2, 2025

11:15 AM – 11:24 AM CT

Location: Music City Center, 202 A

Presenting Author(s)

Manav Mathur (he/him/his)

Medical Student
University of Cincinnati College of Medicine, United States

Author/Co-author(s)

Jacob Byers, M.S.

Student
University of Cincinnati, United States
AM

Abouelmagd Makramalla, MD

Associate Professor of Interventional Radiology
University of Cincinnati, United States
Ali Kord, MD, MPH

Assistant Professor of Radiology
University of Cincinnati Medical Center, United States

Purpose: Biliary anastomotic strictures are a common complication after Roux-en-Y hepaticojejunostomy (HJ) involving up to 38% of patients. These patients are typically managed via percutaneous transhepatic biliary drain (PTBD) placement and serial balloon cholangioplasty with catheter upsizing every 2 weeks for 6 months or more. These patients may fail or are not candidates for intraluminal endoscopic repair or conventional fluoroscopic procedures {1, 2}. This retrospective study is designed to assess the long-term clinical outcome of percutaneous CALI to treat severe benign HJAS refractory to other treatments.

Materials and Methods: 11 patients (median 52 [46 – 71] years, M:F 5:6) with severe HJAS who underwent CALI between 1/2021 and 9/2024 and either failed benign fluoroscopic stricture protocol or were ineligible for intraluminal endoscopic intervention were included in the study. All cases received general anesthesia. Percutaneous endoscopy and cholangiogram were used to precisely delineate and evaluate the stenosis. Laser incision was performed using a p</span>ercutaneous cholangioscope (SpyGlass Discover, Boston Scientific, MA; Pusen Medical, Zhuhai, China) and a 365 µm bare Holmium laser fiber (1.0 J/pulse at a rate of 10 Hz) followed by balloon cholangioplasty and safety biliary drain placement. Patients were followed up to 3 years after the percutaneous laser incision.

Results: The technical success rate was 100%. Clinical success rate, defined as resolution of stenosis on follow-up cholangiogram, was 91% (10/11) at a median of 27 days [16 – 98]. One patient expired two days post-CALI from unrelated complications. One patient had a persistent stricture at initial follow up, underwent a second CALI, and developed a recurrent stricture one year later, which resolved after 11 months of benign stricture protocol. The patient remains catheter free for 6 months.

Conclusion: This study endorses the relative safety and efficacy of percutaneous CALI in treating patients with severe HJAS refractory to other treatments, while demonstrating low rates of recurrence.