Percutaneous transhepatic cholangioscopy-assisted procedures for the management of postoperative benign bilioenteric anastomotic strictures with or without biliary stones

Table 4 Adverse events during percutaneous transhepatic biliary drainage, sinus tract dilation as well as percutaneous transhepatic cholangioscopy-assisted procedures, n (%)

	PTBD (n = 40)	Percutaneous sinus tract dilation (n = 40)	PTCS-assisted anastomotic stricture dilation (n = 31)1	PTCS-assisted anastomotic recanalization (n = 8)	PTCS-assisted stone therapy (n = 36)2
Cholangitis	5 (12.5)	2 (5.0)	2 (6.5)	0 (0.0)	2 (5.6)
Bacteremia	4 (10.0)	2 (5.0)	1 (3.3)	0 (0.0)	0 (0.0)
Right pleural effusion	2 (5.0)	1 (2.5)	0 (0.0)	0 (0.0)	0 (0.0)
Hemobilia	0 (0.0)	1 (2.5)3	1 (3.3)	0 (0.0)	0 (0.0)
Catheter migration	0 (0.0)	1 (2.5)4	0 (0.0)	0 (0.0)	1 (2.8)4
Overall	11 (27.5)	7 (17.5)	4 (12.9)	0 (0.0)	3 (8.3)

¹Including 19 patients with a simple stricture and 8 patients with a complex stricture using balloon dilation and 4 patients with a simple stricture using bougie dilation.

²Including removal using a basket or pushing through the anastomosis by a cholangioscope for small or fragmented stones or electrohydraulic lithotripsy and laser lithotripsy for impacted bile duct stones, or stones unremovable via the sinus tract or anastomosis (e.g., > 1 cm stones).

³Acute bleeding occurred from the sinus tract likely due to a biliovenous fistula caused by blood vessel injury when the catheter was removed and the planned second sinus tract dilation session, bleeding was quickly stopped by compression using another larger catheter.

⁴The catheter was successfully reinserted under ultra-thin cholangioscopy in one case, and with a repeated percutaneous transhepatic biliary drainage procedure in the other.

PTCS: Percutaneous transhepatic cholangioscopy; PTBD: Percutaneous transhepatic biliary drainage.