Our Summary

The research paper discusses a medical procedure called endoscopic balloon dilatation using a double-balloon endoscope (DB-ERC). This technique is used for treating a condition known as hepaticojejunostomy anastomotic stricture (HJAS), which is a narrowing of a surgically-made connection between the liver and small intestine (hepaticojejunostomy) often seen in patients who have had a type of surgery known as the Whipple’s procedure.

The researchers looked back at the case files of 46 patients who had this balloon dilatation treatment for benign (non-cancerous) HJAS between 2008 and 2014. They found that the procedure was successful in all cases, with few adverse events (only 7% of patients developed a liver infection called cholangitis). Patients typically stayed in the hospital for about a week after the procedure.

However, they found that over half of the patients who were followed up for more than a year experienced a recurrence of the stricture at some point. They also noticed that patients whose stricture had formed less than a year after surgery were more likely to experience a recurrence, although this finding was not statistically significant.

In conclusion, while the balloon dilatation technique is effective and safe for treating benign HJAS, improvements are needed to prevent the stricture from recurring.

FAQs

  1. What is endoscopic balloon dilatation using a double-balloon endoscope (DB-ERC) and what is it used for?
  2. What were the findings of the study on the use of DB-ERC in treating hepaticojejunostomy anastomotic stricture (HJAS)?
  3. What improvements are suggested by the study to prevent the recurrence of HJAS after the balloon dilatation technique?

Doctor’s Tip

A helpful tip a doctor might tell a patient about the Whipple procedure is to be aware of the potential for hepaticojejunostomy anastomotic stricture (HJAS) to develop after the surgery. Patients should be vigilant for symptoms such as jaundice, abdominal pain, fever, and nausea, which could indicate a stricture. If these symptoms occur, they should promptly notify their healthcare provider for further evaluation and potential treatment. Additionally, patients who undergo the Whipple procedure should follow up with their healthcare team regularly to monitor for any potential complications, including HJAS.

Suitable For

Patients who have undergone the Whipple procedure, also known as a pancreaticoduodenectomy, are typically recommended for the Whipple procedure. This procedure is commonly used to treat pancreatic cancer, bile duct cancer, duodenal cancer, and other conditions affecting the pancreas, bile ducts, and duodenum. Patients who have developed complications such as hepaticojejunostomy anastomotic stricture (HJAS) after the Whipple procedure may be recommended for endoscopic balloon dilatation using a double-balloon endoscope (DB-ERC) to treat the narrowing in the connection between the liver and small intestine.

Timeline

Before the Whipple procedure:

  • Patient is diagnosed with a condition that requires a Whipple procedure, such as pancreatic cancer or tumors in the pancreas, bile duct, or small intestine.
  • Patient undergoes pre-operative testing and preparation, including imaging scans and blood tests.
  • Patient may receive chemotherapy or radiation therapy before the surgery to shrink the tumor.
  • Patient undergoes the Whipple procedure, which involves removing a portion of the pancreas, small intestine, bile duct, and sometimes the stomach.
  • Patient stays in the hospital for about a week after the surgery to recover.

After the Whipple procedure:

  • Patient may experience pain, fatigue, and difficulty eating in the days and weeks following the surgery.
  • Patient is monitored for any complications, such as infection or leakage from the surgical site.
  • Patient begins a gradual recovery process, including physical therapy and dietary changes.
  • Patient may need to take medications to manage pain, prevent infection, and aid digestion.
  • Patient may undergo follow-up imaging scans and blood tests to monitor for any signs of recurrence or complications.
  • Patient may need additional treatments, such as chemotherapy or radiation therapy, depending on the underlying condition.

What to Ask Your Doctor

Here are some questions a patient should ask their doctor about the Whipple procedure:

  1. What is the purpose of the Whipple procedure and why is it recommended for me?
  2. What are the potential risks and complications associated with the Whipple procedure?
  3. What is the expected recovery time after the Whipple procedure?
  4. How will my diet and lifestyle need to change after the Whipple procedure?
  5. How often will I need follow-up appointments after the Whipple procedure?
  6. Are there any alternative treatment options to the Whipple procedure?
  7. What can I do to optimize my chances of a successful outcome from the Whipple procedure?
  8. How likely am I to experience a recurrence of the condition after the Whipple procedure?
  9. What symptoms should I watch out for that may indicate a complication or recurrence after the Whipple procedure?
  10. Are there any specific medications or therapies that can help prevent a recurrence of the condition after the Whipple procedure?

Reference

Authors: Mizukawa S, Tsutsumi K, Kato H, Muro S, Akimoto Y, Uchida D, Matsumoto K, Tomoda T, Horiguchi S, Okada H. Journal: BMC Gastroenterol. 2018 Jan 18;18(1):14. doi: 10.1186/s12876-018-0742-x. PMID: 29347923