Benign biliary strictures treated with biodegradable stents in patients with surgically altered anatomy using double balloon enteroscopy

Figures & data

Figure 1. Archimedes stent (amg International GmbH, Winsen, Germany) has a helical structure allowing the bile flow on the outer extremity of the stent while supporting the opening of the lumen. The stent has anatomical shape, tapered tip, and proximal and distal flaps.

Table 1. Patient characteristics.

Patient	Gender	Age (yr)	Underlying disease	Operation, reconstruction	Previous ERCs (n)	Previous ERC procedures
1	Male	56	Echinococcosis, ALL	Liver resection, HJ (Roux-en-Y)	1	ERC
2	Female	49	PSC	liver transplantations, HJ (Roux-en-Y)	2	Dilation, plastic stent
3	Female	55	Biliary injury	HJ (Roux-en-Y)	1	Dilation, stone removal
4	Female	72	Cholangiocarcinoma	Liver resection, HJ (Roux-en-Y)	1	Dilation
5	Female	26	PSC/AIH, UC	Liver transplantation, HJ (Roux-en-Y)	1	Dilation
6	Male	30	PSC, UC	Liver transplantation, HJ (Roux-en-Y)	1	Dilation
7	Female	34	PSC, UC	Liver transplantation, HJ (Roux-en-Y)	3	Dilations

yr: years; ALL: acute lymphocyte leukemia; ERC: endoscopic retrograde cholangiography; HJ: hepaticojejunostomy; PSC: primary sclerosing cholangitis; AIH: autoimmune hepatitis; UC: ulcerative colitis; n: number.

Table 2. Procedural characteristics.

Patient	Indication	Site of stricture	Dilation (mm)	Length of stent (cm)	Diameter of stent (mm)	Procedural length (min)
1	Cholangitis, stones	Anastomotic	12	6 + 6	2.6	90
2	Cholangitis	Intrahepatic	6	8	2.6	46
3	Cholangitis	Anastomotic	10	6 + 8 + 8	2.6	56
4	Cholangitis	Anastomotic	8	6 + 6	2.6	52
5	Elevated liver enzymes	Intrahepatic	8	8	2.6	28
6	Elevated liver enzymes	Intrahepatic	7	6	2.6	119
7	Cholangitis	Intrahepatic	6	6	2.6	63

Figure 2. The fluoroscopy views of patient (number 1) with hepaticojejunostomy anastomotic stricture (a) before and (b) after stenting with Archimedes stents.

Figure 3. The fluoroscopy views of patient (number 2) with left site intrahepatic stricture (a) before and (b) after stenting with Archimedes stent.

Figure 4. The fluoroscopy view of patient with hepaticojejunostomy anastomotic stricture (number 3).

Figure 5. The fluoroscopy view of Archimedes stents of patient with hepaticojejunostomy anastomotic stricture (number 3) showing good visibility of the stents.

Figure 6. The endoscopy view of Archimedes stents of patient with hepaticojejunostomy anastomotic stricture (number 3).

Figure 7. The fluoroscopy views of patient (number 4) with hepaticojejunostomy anastomotic stricture (a) before and (b) after stenting with Archimedes stents.

Figure 8. The fluoroscopy views of patient (number 5) with left site intrahepatic stricture (a) before and (b) after stenting with Archimedes stent.

Figure 9. The fluoroscopy views of patient (number 6) with left site intrahepatic stricture (a) before and (b) after stenting with Archimedes stent.

Figure 10. The fluoroscopy view of patient (number 7) with right site intrahepatic stricture before stenting.

Table 3. Follow up data.

Patient	Bilirubin, ALP (pre)	Bilirubin, ALP (post)	Hospitalization (d)	30 day follow up	90 day follow up	Total follow up	Other procedures
						(d)	(n)
1	15, 171	14, 131	5	Cholangitis	–	648	–
2	11, 335	11, 333	1	–	Cholangitis, stent migration,	634	ERC (2), plastic stent (1)
3	5, 139	7, 151	2	–	Pain	620	ERC
4	42, 118	-, -	1	–	–	599	–
5	23, 192	27, 217	1	Rise in enzymes	–	564	–
6	35, 210	27, 175	2	–	–	480	–
7	26, 236	31, 340	2	Cholangitis	Cholangitis	418	Liver retransplantation

Bilirubin umol/l; normal value <20, ALP: alkaline phosphatase U/l, normal value 35–105; d: days; n: number; ERC: endoscopic retrograde cholangiography.