Min Young Do1, Sung Ill Jang1, Jae Hee Cho1, Kwang-Hun Lee2, Seung-Moon Joo2, Moon Jae Chung3, Dong Ki Lee1

1Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, 2Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, 3Department of Internal Medicine, Sinchon Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Background/Aims: Post-cholecystectomy biliary stricture can be treated surgically or non-surgically. Endoscopic or percutaneous treatments are preferentially attempted for post-cholecystectomy biliary stricture. However, these conventional methods are not feasible if a guide wire cannot be passed through the stricture. This study evaluated the usefulness of magnetic compression anastomosis(MCA) in post-cholecystectomy biliary stricture which could not be treated with conventional methods.

Methods: MCA was performed in patients with the post-cholecystectomy biliary stricture that had not been resolved with conventional endoscopic or percutaneous treatments. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and the other magnet was advanced using endoscopic retrograde choangiopancreatography(ERCP) via common bile duct. After magnet approximation and recanalization, a fully covered self-expandable metal stent(FCSEMS) was exchanged every 3 months and placed for six months. The stricture resolution was evaluated after removal of the FCSEMS.

Results: This study followed nine patients who underwent MCA after the development of post-cholecystectomy biliary stricture. Recanalization was successfully achieved in all patients (technical success rate: 100%). There were three types of Strasburg classifications of biliary injury from cholecystectomy: type B (n=2), type C (n=3), type E (n=4). The mean follow-up period after recanalization was 43.5 months

Conclusion: MCA represents an alternative and useful nonsurgical method of post-cholecystectomy biliary stricture that cannot be treated with conventional methods.

Keywords: magnetic compression anastomosis, post-cholecystectomy, biliary stricture