Comparative study of therapeutic outcomes in patients who developed hepatolithiasis after hepaticojejunostomy: balloon-assisted enteroscopic approach versus percutaneous transhepatic approach

Kazuki Nakamura; Yasutaka Ishii; Yumiko Tatsukawa; Shinya Nakamura; Juri Ikemoto; Sayaka Miyamoto; Masaru Furukawa; Noriaki Iijima; Keiji Hanada; Shiro Oka

doi:10.1007/s00464-024-11479-2

Comparative study of therapeutic outcomes in patients who developed hepatolithiasis after hepaticojejunostomy: balloon-assisted enteroscopic approach versus percutaneous transhepatic approach

Surg Endosc. 2024 Dec 23. doi: 10.1007/s00464-024-11479-2. Online ahead of print.

Authors

Affiliations

¹ Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
² Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. yishii@hiroshima-u.ac.jp.
³ Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan.

PMID: 39715955
DOI: 10.1007/s00464-024-11479-2

Abstract

Background: The treatment of hepatolithiasis in patients who underwent hepaticojejunostomy (HJS) is challenging. In this study, we aimed to clarify the therapeutic outcomes of double balloon enteroscopy (DBE) and percutaneous transhepatic biliary drainage (PTBD) for hepatolithiasis after HJS.

Methods: Patients who underwent DBE or PTBD for hepatolithiasis after HJS at Hiroshima University Hospital were enrolled, and treatment outcomes and recurrence were compared.

Results: Forty-eight of the 84 eligible patients underwent DBE, with the HJS site reached in 42 patients (87.5%; DBE group). Forty-one patients underwent PTBD (PTBD group). There were no differences in the clinical characteristics and stone-related factors, including localization, maximum diameter, and quantity, between both groups. The complete stone removal rates in the DBE and PTBD groups were 85.7% and 90.2%, respectively. The DBE group had a significantly shorter median length of hospital stay than the PTBD group (6 vs. 21 days, P < 0.001). During a median follow-up of 45 months, stone recurrence was observed in 22 (32.8%) patients. The cumulative recurrence rates at 1, 3, 5, and 10 years were 13.1%, 31.8%, 34.9%, and 52.7%, respectively. The stone recurrence rates of the DBE and PTBD groups were not significantly different (28.6% vs. 37.5%). Multivariate analysis revealed a stone diameter > 8 mm (hazard ratio, 2.602; P = 0.026) and age ≥ 70 years (hazard ratio, 3.077; P = 0.017) as independent risk factors for stone recurrence.

Conclusions: DBE showed outcomes comparable to those of PTBD in the treatment of hepatolithiasis in patients who underwent HJS. Although reaching the HJS site is difficult in some cases, treatment can be completed within a short period with DBE; therefore, it could be the first choice of treatment for hepatolithiasis after HJS.

Keywords: Double balloon enteroscopy; Hepaticojejunostomy; Hepatolithiasis; Percutaneous transhepatic biliary drainage; Recurrence.