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Treatment of completely obstructed benign biliary strictures with magnetic compression anastomosis: Follow-up results after recanalization

 Sung Ill Jang  ;  Kwang-Hun Lee  ;  Hong Jin Yoon  ;  Dong Ki Lee 
 Gastrointestinal Endoscopy, Vol.85(5) : 1057-1066, 2017 
Journal Title
 Gastrointestinal Endoscopy 
Issue Date
Adult ; Aged ; Anastomosis, Surgical* ; Biliary Tract Surgical Procedures ; Cholestasis/therapy* ; Constriction, Pathologic/therapy ; Device Removal ; Drainage ; Endoscopy, Digestive System/methods* ; Female ; Humans ; Liver Transplantation ; Magnets* ; Male ; Middle Aged ; Postoperative Complications/therapy*
BACKGROUND AND AIMS: Although nonsurgical methods produce high clinical success rates in the treatment of benign biliary stricture (BBS), conventional methods are not always successful in cases of severe biliary stricture or complete obstruction. Therefore, the efficacy of magnetic compression anastomosis (MCA) for treatment of refractory BBS was evaluated in a single-center, nonrandomized study. METHODS: MCA was performed in patients with BBS that was not resolved by conventional endoscopic or percutaneous treatments. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and the other advanced through 1 of 3 different routes. After magnet approximation and recanalization, an internal drainage catheter was placed for 6 months. RESULTS: This study followed 39 patients who underwent MCA after the development of postoperative or traumatic strictures. Recanalization was achieved successfully in 35 patients. There was an acceptable procedure-related adverse event of mild cholangitis in 1 patient and no procedure-related mortalities. The average elapsed time from magnet approximation to removal was 57.4 days (range, 13-182 days), and the mean follow-up period after recanalization was 41.9 months (range, 7.1-73.4 months). Restenosis after MCA recurred in 1 patient, and partial restenosis occurred in another patient, but recanalization in these patients was successful using a guidewire via the percutaneous and endoscopic tracts. CONCLUSIONS : MCA represents an alternative nonsurgical recanalization method for BBSs that cannot be treated by conventional methods. The rate of stricture recurrence after MCA was lower than that after conventional methods, likely because of the creation of a new fistula tract instead of dilation of a previous stricture.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
윤홍진(Yoon, Hong Jin)
이광훈(Lee, Kwang Hun)
이동기(Lee, Dong Ki) ORCID logo https://orcid.org/0000-0002-0048-9112
장성일(Jang, Sung Ill) ORCID logo https://orcid.org/0000-0003-4937-6167
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