Efficacy and Safety of a 6-Month Placement of a Fully Covered Self-Expanding Metal Stent for Refractory or Recurrent Hepaticojejunostomy Anastomotic Stricture via Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography.

Objectives: Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-assisted ERCP) is performed for hepaticojejunostomy anastomotic stricture (HJAS) after biliary-enteric anastomosis. Although endoscopic balloon dilation (EBD) and plastic stent (PS) placement are commonly performed, they result in high recurrence rates. Studies have demonstrated the efficacy of fully covered self-expanding metal stents (FCSEMS) in HJAS management; however, none have systematically evaluated the outcomes of 6-month placement. Therefore, this retrospective study aimed to evaluate the efficacy and safety of a 6-month FCSEMS placement for benign refractory or recurrent HJAS. Methods: We evaluated patients who underwent initial treatment with EBD alone or EBD plus PS placement via BE-assisted ERCP between April 2015 and March 2024. Among them, patients with refractory or recurrent HJAS received 6-month FCSEMS placements. The study outcomes were HJAS resolution, adverse events (AEs), and recurrence rates. Results: Among 92 patients who underwent initial EBD alone or EBD with PS placement, the HJAS resolution rate was 90.2%. The median follow-up period after the initial treatment was 16.1 months, with recurrence observed in 48.2% of patients. Among the 34 patients with refractory or recurrent HJAS, FCSEMS placement achieved a resolution rate of 97.1% in a median of 182 days. AEs occurred in 14.7% of patients (moderate, Conclusions: The 6-month FCSEMS placement for refractory or recurrent HJAS showed high efficacy and safety, indicating its potential as a preferred treatment option.