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Utilization of a Modified Roux-en-Y Anastomosis as an Access point for Percutaneous Transjejunal Cholangioplasty of Recurrent Biliary Strictures

  • Clinical Investigation
  • Biliary
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Introduction

Biliary duct injuries pose a significant management challenge due to the propensity for recurrent biliary strictures. Development of a modified Roux-en-Y hepaticojejunostomy known as a Hutson–Russell Pouch (HRP) provides a point of entry for repetitive access to the biliary tree. We aim to highlight the effectiveness of using the HRP as an access point for the long-term management of anastomotic and distal biliary strictures, thereby showcasing the value in potential widespread adoption of this modification to a standard surgical procedure.

Materials and methods

IRB-approved retrospective study of 36 patients (10 M, 26 F; mean age 55.19 ± 13.94; 15–83) underwent a total of 110 transjejunal cholangiograms. Indications for cholangiogram included cholangitis (n = 38), surveillance (n = 36), and elevated liver enzymes (n = 36). Technical success was defined by the ability to access and intervene in the biliary tree via HRP access. In case of stenosis, the ability to successfully dilate (< 30%) residual stenosis was considered a technically successful procedure. Clinical success was defined by normalization of the liver function tests or resolution of cholangitis.

Results

Technical success was achieved in 83/110 (75.45%) of the cases, and clinical success was achieved in 102/110 (98.2%). Transhepatic access was needed in 27/110 (24.5%) of the cases. Interventions performed included balloon cholangioplasty in 104/110 (94.5%), biliary stone removal in 2/110 (1.8%), biliary stent placement in 2/110 (1.8%), and biliary drain placement in 4/110 (3.6%). There were a total of 9/110 complications (8.2%).

Conclusion

The HRP was an effective access point in the management of recurrent benign biliary strictures in this cohort.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA

    Jagteshwar Sandhu & Adam Swersky

  2. Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA

    Jason Salsamendi, Shree Venkat & Prasoon Mohan

  3. Diagnostic and Interventional Radiologist, Haywood Medical Imaging, Clyde, NC, USA

    Robert B. Abrahams

  4. Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA

    Danny Sleeman

Authors
  1. Jagteshwar Sandhu
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  2. Adam Swersky
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  3. Jason Salsamendi
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  4. Robert B. Abrahams
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  5. Shree Venkat
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  6. Danny Sleeman
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  7. Prasoon Mohan
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Corresponding author

Correspondence to Jagteshwar Sandhu.

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The authors declare they have no conflicts of interest.

Ethical Approval

This study has obtained IRB approval from the University of Miami/Jackson Memorial Hospital, and the need for informed consent was waived.

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Consent for publication was obtained for every individual person’s data included in this study.

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Sandhu, J., Swersky, A., Salsamendi, J. et al. Utilization of a Modified Roux-en-Y Anastomosis as an Access point for Percutaneous Transjejunal Cholangioplasty of Recurrent Biliary Strictures. Cardiovasc Intervent Radiol 42, 1745–1750 (2019). https://doi.org/10.1007/s00270-019-02335-1

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  • DOI: https://doi.org/10.1007/s00270-019-02335-1

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