Balloon Dilation of Biliary Stenosis

Background and indications

Balloon dilation of biliary stricture (cholangioplasty) is a percutaneous procedure to widen bile duct stenosis. It is mainly indicated for benign biliary strictures: post-surgical biliodigestive anastomotic strictures (choledochojejunostomy, hepaticojejunostomy), post-liver transplant strictures, post-cholecystectomy strictures (iatrogenic common bile duct injury), and primary sclerosing cholangitis (PSC).

Pre-procedure assessment

Assessment includes biliary MRI (MRCP), pre-existing percutaneous biliary drain (dilation is performed via existing biliary access), and hepatic blood panel. Percutaneous biliary access is often established 1-2 weeks before dilation.

Procedure

Under sedation, through existing percutaneous biliary access, a dilation balloon (6-10 mm diameter) is positioned at the stricture under fluoroscopic guidance. The balloon is inflated for 1-3 minutes, repeated 2-3 times. A large-bore biliary drain is left in place for 2-4 weeks after dilation to maintain patency. The procedure takes 30-60 minutes.

Results and scientific evidence

Technical success rate is 90-95%. For biliodigestive anastomotic strictures, long-term patency rate (> 2 years) is 60-80% after 1-3 dilation sessions. Recurrent strictures may require iterative dilations or biliary stent placement. For post-transplant strictures, success rate is 70-85%.

Risks and complications

Cholangitis (5-10%), hemorrhage (hemobilia: 2-3%), biliary perforation (< 1%), pancreatitis (< 1%, if low stricture). Systematic antibiotic prophylaxis.

Recovery

1-2 night hospitalization. Biliary drain maintained 2-4 weeks then progressively removed after cholangiographic patency verification.

Practical information

The procedure is performed as a short inpatient stay. It is performed by an interventional radiologist, in coordination with the hepatic surgeon and gastroenterologist.