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TRANSLUMINAL ANTEGRADE PIECEMEAL DILATION TECHNIQUE FOR HEPATICOJEJUNOSTOMY STRICTURE WITH CHOLANGIOSCOPIC EVALUATION

Kimi Bessho 1, Takeshi Ogura 1, Atushi Okuda 1, Saori Ueno 1, Nobu Nishioka 1, Masanori Yamada 1, Masahiro Yamamura 1, NOBUHIRO HATTORI 1, Hiroki Nishikawa 1

Affiliations

1 Osaka Medical and Pharmaceutical University, Osaka, Japan

Summary

AI Generated

A retrospective study of 19 patients evaluated transluminal antegrade piecemeal dilation technique (TAPD) using a drill dilator for treating hepaticojejunostomy stricture, finding a 78.9% technical success rate with no bleeding, perforation, or recurrence during follow-up.

TAPD was attempted around 11 days after EUS-HGS in 19 patients with symptomatic hepaticojejunostomy stricture; guidewire passage was unsuccessful in 4 patients, yielding a technical success rate of 78.9%.
Among the 15 patients in whom guidewire passage was achieved, TAPD was successful in all cases, with cholangioscopy identifying no bleeding or perforation in any patient.
No recurrence of hepaticojejunostomy stricture was observed during the follow-up period in any patient who underwent TAPD.
The authors conclude that TAPD appears technically feasible and safe, though randomized trials with long-term follow-up are needed to compare it with other methods.
This material is most relevant to interventional endoscopists managing post-surgical biliary strictures.

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Abstract

Introduction

Balloon dilation and plastic stent deployment have been performed as hepaticojejunostomy stricture (HJS) treatment techniques by PTBD or under DB-ERCP guidance. Although these techniques have shown favorable clinical results, the treatment period can be long because stent deployment is required. In addition, HJS may recur even after treatment because the scar tissue itself remains. To overcome these challenges, we developed an transluminal antegrade piecemeal dilation technique (TAPD) for treating HJS. The aim of this study was to evaluate the technical feasibility and safety of this technique in terms of the pre- and post-cholangioscopic findings.

Aims & Methods

This retrospective study included consecutive patients who were complicated with symptomatic HJS between November and February 2022. The primary outcome of this study was the technical success rate of TAPD using a drill dilator. Technical success was defined as resolution of the HJS, based on the cholangioscopic findings. The secondary outcome was adverse events associated with TAPD such as bleeding or perforation.

Results

TAPD was attempted at around 11 days after EUS-HGS in 19 patients. Among the 19 patients, passage of the guidewire across the HJS into the intestine was unsuccessful in 4 patients, and the technical success rate of this procedure was 78.9%. TAPD was successful in all 15 patients in whom passage of the guidewire was achieved. After TAPD, cholangioscopy identified no bleeding or perforation in any patient. During the follow-up period, no recurrence of HJS was observed in any patient who underwent TAPD.

Conclusion

In conclusion, TAPD appears to be technically feasible and safe. Although it is necessary to conduct a randomized trial in comparison with other methods, with long-term follow up, TAPD may be a useful option for the treatment of HJS.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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The walking frail patient: Clinical impact and prognosis

Federico Ravaioli 1

Affiliations

1 University of Bologna, Bologna, Italy

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Abstract

Event

UEG Week Barcelona 2026

Topics

Primary Care Hepatobiliary

Session

Frailty, cachexia and sarcopenia in liver disease

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Hiroki Nishikawa

UEG Presentation

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Pathophysiology: Why does muscle go away?

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Pathophysiology: Why does muscle go away?

Alberto Zanetto 1

Affiliations

1 Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

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Abstract

Event

UEG Week Barcelona 2026

Topics

Primary Care Hepatobiliary

Session

Frailty, cachexia and sarcopenia in liver disease

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Ailsa L Hart

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Hiroki Nishikawa

UEG Presentation

New

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Immunometabolism as a therapeutic concept in inflammatory bowel disease

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Immunometabolism as a therapeutic concept in inflammatory bowel disease

Bram Verstockt 1

Affiliations

1 University Hospitals Leuven and KU Leuven, Translational Research in Gastrointestinal Disorders - IB, Leuven, Belgium

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Abstract

Event

UEG Week Barcelona 2026

Topics

Hepatobiliary Immunology Digestive Oncology Colorectal

Session

Cellular perspectives of immune control

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Hiroki Nishikawa

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CONTEMPORARY TEMPORAL TRENDS IN COLECTOMY AND RESTORATIVE SURGERY FOR ULCERATIVE COLITIS: AN ANALYSIS OF THE UK IBD BIORESOURCE

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CONTEMPORARY TEMPORAL TRENDS IN COLECTOMY AND RESTORATIVE SURGERY FOR ULCERATIVE COLITIS: AN ANALYSIS OF THE UK IBD BIORESOURCE

Itai Ghersin 1,2, Qian Zhang 3, Hashem Mahdi M. Saleh Al-Dujaily 4, Orestis E. Argyriou 5, Kapil Sahnan 5, Laura Fachal 3, Laura Hancock 6, Jonathan P Segal 7, Miles Parkes 8, Ailsa L Hart 5

Affiliations

1 Rambam Health Care Campus, Haifa, Israel

2 St. Mark's Hospital and Academic Institute, London, United Kingdom

3 Wellcome Sanger Institute, Hinxton - Saffron Walden, United Kingdom

4 Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom

5 St Mark’s Hospital and Academic Institute, London, United Kingdom

6 Manchester University NHS Foundation Trust, Manchester, United Kingdom

7 Royal Melbourne Hospital, Melbourne, Australia

8 Inflammatory Bowel Disease Research Group, Addenbrooke's Hospital, Cambridge, UK, Cambridge, United Kingdom

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Abstract

Introduction

The surgical landscape for ulcerative colitis (UC) is evolving alongside the expanding use of advanced medical therapies. Whether the introduction and widespread adoption of biologic and small-molecule therapies have altered the long-term need for colectomy in UC remains controversial. In addition, the surgical pathway following subtotal colectomy remains a point of clinical variation. Restoration of intestinal continuity can be achieved via ileal pouch-anal anastomosis (IPAA), traditionally considered the gold standard, or ileo-rectal anastomosis (IRA)¹. However, a significant proportion of patients opt for a permanent ileostomy. Recent data highlight considerable international and regional variability in these practices².

Aims & Methods

We aimed to describe the contemporary landscape of UC surgery using the UK IBD BioResource, a national platform recruiting from over 100 centres³.
We analysed patients with a confirmed diagnosis of UC undergoing a subtotal colectomy. Temporal trends in colectomy incidence and IPAA uptake were evaluated across two eras, using 2012 as a cut-off to reflect the period following the widespread availability of anti-TNF maintenance and newer agents. Risk of colectomy was assessed using Cox regression, and IPAA formation was evaluated using multivariable logistic regression.

Results

Our cohort included 14,248 patients with UC. Of those patients, 965 (6.8%) underwent a subtotal colectomy.
The risk of colectomy was significantly lower in the recent era (after 2012) compared with the earlier era (HR 0.81, 95% CI 0.67–0.98, p=0.028).
Among those with a colectomy and fully available surgical details (n=627), 333 (53%) had an ileo-anal pouch and 294 (47%) did not.
Most notably, patients undergoing colectomy after 2012 were significantly less likely to receive an ileo-anal pouch than those in the earlier era (OR 0.11, 95% CI 0.07–0.16, p<0.001).
Indications for colectomy have remained stable across eras.
Among patients who underwent a subtotal colectomy without a subsequent IPAA, 61.5% had the rectum remaining in situ, whereas 28.5% underwent completion proctectomy.

Conclusion

We demonstrate a previously unreported and significant decline in the uptake of restorative pouch surgery after colectomy for UC in the UK.
This trend may reflect shifts in surgical decision-making and/or evolving patient preferences.
Further research is needed to elucidate the underlying drivers of this marked shift in clinical practice.

References

1. Worley GHT, Vaughan-Shaw P, Sahnan K. Surgical management of ulcerative colitis. Br J Surg. 2023 Jul 17;110(8):885-887.
2. Worley G, Nordenvall C, Askari A, Pinkney T, Burns E, Akbar A, Olén O, Ekbom A, Bottai M, Myrelid P, Faiz O. Restorative surgery after colectomy for ulcerative colitis in England and Sweden: observations from a comparison of nationwide cohorts. Colorectal Dis. 2018 Sep;20(9):804-812.

3. Parkes M; IBD BioResource Investigators. IBD BioResource: an open-access platform of 25 000 patients to accelerate research in Crohn's and Colitis. Gut. 2019 Sep;68(9):1537-1540.

Event

UEG Week Barcelona 2026

Topics

Surgery IBD

Submission format

Abstract

Session

Real-world observations in IBD: Things we don't see in clinical trials

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Hiroki Nishikawa

UEG Presentation

New

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Hope: Potential tools for personalised therapy

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Hope: Potential tools for personalised therapy

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Surgery Pancreas Mechanisms & Personalised Medicine

Session

Future treatment for resectable pancreatic cancer: Cut, treat or personalise?

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Federico Ravaioli

Pathophysiology: Why does muscle go away?

Alberto Zanetto

Immunometabolism as a therapeutic concept in inflammatory bowel disease

Bram Verstockt

CONTEMPORARY TEMPORAL TRENDS IN COLECTOMY AND RESTORATIVE SURGERY FOR ULCERATIVE COLITIS: AN ANALYSIS OF THE UK IBD BIORESOURCE

Ailsa L Hart

Hope: Potential tools for personalised therapy

PROPENSITY SCORE MATCHING ANALYSIS FOR CLINICAL IMPACT OF BRAIDED- VERSUS LASER-CUT-TYPE COVERED SELF-EXPANDABLE METAL STENTS FOR EUS-GUIDED HEPATICOGASTROSTOMY

Hiroki Nishikawa

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PROPENSITY SCORE MATCHING ANALYSIS FOR CLINICAL IMPACT OF BRAIDED- VERSUS LASER-CUT-TYPE COVERED SELF-EXPANDABLE METAL STENTS FOR EUS-GUIDED HEPATICOGASTROSTOMY

Saori Ueno 1, Takeshi Ogura 1, Hiroki Nishikawa 1

Affiliations

1 Osaka Medical and Pharmaceutical University, Takatsukishi, Japan

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Abstract

Introduction

To prevent stent migration during EUS-HGS, intra-scope channel release technique is important, but are unfamiliar to non-expert hands. The self-expandable metal stent (SEMS) is an additional factor to prevent stent migration. However, no comparative studies of laser-cut and braided types during EUS-HGS have been reported.

Aims & Methods

The aim of this study was to compare the distance between the intrahepatic bile duct and stomach wall after EUS-HGS among laser-cut- and braided-type SEMS. To evaluate stent anchoring function, we measured the distance between the hepatic parenchyma and stomach wall before EUS-HGS, one day after EUS-HGS, and 7 days after EUS-HGS.　Also, propensity score matching was performed to create a propensity score for using Laser cut type group and Braided group with a logistic regression model.

Results

A total 144 patients were enrolled in this study. Among them, 24 patients underwent EUS-HGS using a laser-cut-type SEMS, and 118 patients underwent EUS-HGS using a braided-type SEMS. EUS-HGS using the laser-cut-type SEMS was mainly performed by non-expert endoscopists (n=21). However, EUS-HGS using braided-type SEMS was mainly performed by expert endoscopists (n=98), showing a significant difference. The distance after 1 day was significantly shorter with the laser-cut-type group (2.91 ± 1.88 mm) compared with the braided-type group (8.19 ± 6.07 mm). In addition, this distance remained significantly shorter in the laser-cut type group compared with the braided-type group after 7 days.　Although these results were similar after propensity score matching analysis, the distance between hepatic parenchyma and stomach after 7 days was increased 4mm compared with the distance after 1 day in Braided group. On the other hand, in Laser cut type group, the distance after 1 day and 7 days was almost same.

Conclusion

In conclusion, EUS-HGS using a laser-cut-type SEMS may be safe to prevent stent migration, even in non-expert hands, compared with a braided-type SEMS, although a randomized trial is warranted.

Disclosure

None

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

More Like This:

The walking frail patient: Clinical impact and prognosis

Federico Ravaioli

Pathophysiology: Why does muscle go away?

Alberto Zanetto

Immunometabolism as a therapeutic concept in inflammatory bowel disease

Bram Verstockt

CONTEMPORARY TEMPORAL TRENDS IN COLECTOMY AND RESTORATIVE SURGERY FOR ULCERATIVE COLITIS: AN ANALYSIS OF THE UK IBD BIORESOURCE

Ailsa L Hart

Hope: Potential tools for personalised therapy

PROPENSITY SCORE MATCHING ANALYSIS FOR CLINICAL IMPACT OF BRAIDED- VERSUS LASER-CUT-TYPE COVERED SELF-EXPANDABLE METAL STENTS FOR EUS-GUIDED HEPATICOGASTROSTOMY

Hiroki Nishikawa