Balloon dilatation of intrahepatic duct and biliary-enteric anastomosis strictures. Long term results

From June 1984 to December 1986, 13 patients with 15 benign bile duct strictures were treated by Gruntzig balloon dilatation via the T-tube fistula or transhepatic route. The patients were 7 men and 6 women; ages ranged from 24 to 63 years old. The site of strictures were hepatojejunostomy in six, right intrahepatic duct in 4, left intrahepatic duct in 4 and one choledochoduodenostomy. Eleven out of 13 patients with bile duct strictures had intrahepatic stones. Ninety-three percent (14/15) of the strictures were successfully dilated by the Gruntzig balloon catheter. After the biliary stent was inserted for 2 to 6 months, follow-up cholangiogram or choledochoscopy revealed good patency of the biliary tree. Ninety-one percent (10/11) of the intrahepatic stones were removed completely by choledochoscopy. No major complication was found during balloon dilatation, except tolerable wound pain. Five patients (45%) developed symptoms during the follow-up period of 5 to 7 1/2 years. Two patients complained of right upper quadrant (RUQ) pain and 3 patients developed acute cholangitis which was treated by percutaneous biliary drainage again or laparotomy. Balloon dilatation for biliary-enteric anastomosis and intrahepatic duct strictures is a nonsurgical, simple and effective procedure, but the incidence of restenosis rate is high and up to 45% within a long-term follow-up period of 5 to 7 1/2 vears.