BACKGROUND Hepaticojejunostomy anastomotic stricture (HJS) is a rare complication after pancreatoduodenostomy. However, the rate of HJS may be increased with the expansion of operative indications, such as intraductal papillary mucinous neoplasm. Recently, the indications for EUS-guided biliary drainage to treat benign biliary disease have expanded. Recently, novel transluminal treatment protocol has been established in our hospital. The aim of this study was thus to evaluate the technical feasibility and safety of our treatment protocol. PATIENTS AND METHOD Consecutive patients with complications of HJS between January and December 2018 were enrolled in this study. EUS-guided hepaticogastrostomy (HGS) is firstly performed. After 7 days to create the fistula, HGS stent is removed. HJS is transluminally evaluated by a cholangioscope, and antegrade balloon dilation is attempted. After 3 months, if HJS is still presence, antegrade stent deployment is performed using a covered metal stent. Also, after 1 month, antegrade stent removal is transluminally performed. RESULTS Among total 29 patients, 14 patients were underwent antegrade metal stent deployment. The technical success rate of antegrade stent deployment was 92.9%. Median period of stent placement was 30.5 days (range 28-38 days), and transluminal stent removal was successfully performed in all patients. During follow-up (median 278 days; range 171-505 days), recurrence of HJS was seen in 2 patients. Severe adverse events were not seen in any patients during follow-up period. CONCLUSION Transluminal stent deployment for HJS under EUS-guidance appears feasible and safe, although further study with a larger sample size and longer follow-up is warranted.

中文翻译：

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使用覆盖式自膨胀金属支架进行肝空肠吻合口狭窄的新型腔内治疗方案。

背景技术肝空肠吻合术（HJS）是胰十二指肠吻合术后罕见的并发症。然而，HJS的发生率可能随着手术指征的扩大而增加，例如导管内乳头状粘液性肿瘤。最近，EUS指导胆道引流治疗良性胆道疾病的适应症有所扩大。最近，我们医院建立了新型的经腔治疗方案。因此，本研究的目的是评估我们治疗方案的技术可行性和安全性。患者与方法本研究纳入了2018年1月至2018年12月间患有HJS并发症的连续患者。首先进行EUS引导的肝胃造口术（HGS）。造瘘7天后，将HGS支架取出。通过胆管镜对HJS进行腔内评估，并尝试进行顺行球囊扩张。3个月后，如果仍然存在HJS，则使用覆盖的金属支架进行顺行支架展开。同样，在1个月后，行腔内切除顺行性支架。结果在29例患者中，有14例进行了顺行金属支架置入术。顺行支架部署的技术成功率为92.9％。支架置入的中位时间为30.5天（范围为28-38天），所有患者均成功完成了经腔支架置入术。在随访中（中位278天；范围171-505天），有2例患者出现HJS复发。随访期间未见任何患者出现严重不良事件。结论在EUS指导下对HJS进行腔内支架置入看来是可行和安全的，