Benign hepaticojejunostomy strictures after pancreatoduodenectomy

Abstract Purpose; To determine the causes of benign hepaticojejunostomy strictures (BHSs) after pancreaticoduodenectomy (PD) and the outcome of endoscopic retrograde cholangiography (ERC) treatment for BHSs. Methods; A total of 175 patients who underwent PD between January 2013 and December 2020 and who were able to be followed up for at least 1 year were included. The preoperative data, operative outcomes, and postoperative course were compared between the BHS group and the group of patients who did not develop stenosis during follow-up (non-BHS group). The course of treatment in the BHS group was also tabulated. Results; Of the patients who underwent anastomosis of the common hepatic duct and jejunum, 13 required invasive treatment due to BHS (7.4%). Multivariate analysis in the BHS and non-BHS groups identified male sex (OR; 3.753, 95% CI; 1.029–18.003, P = 0.0448) and a preoperative bile duct diameter less than 8.8 mm (OR; 7.51, 95% CI; 1.75–52.40, P = 0.0053) as independent risk factors for the development of BHS. In the BHS group, all patients underwent ERC using enteroscopy. The success rate of the ERC approach to the bile duct was 92.3%. Plastic stents were inserted in 6 cases, and metallic stents were inserted in 3 cases. The median observation period since the last ERC was 17.9 months, and there was no recurrence of stenosis in any of the 13 patients. Conclusions; Patients with narrow bile ducts are at higher risk of BHS after PD. Recently, BHS after PD has been treated with ERC-related procedures, which may reduce the burden on patients.