Endoscopic and retrograde cholangiographic appearance of hepaticojejunostomy strictures: A practical classification

Table 1 Demographic, clinical and endoscopic data in patients undergoing endoscopic retrograde cholangio pancreatography with the double balloon enteroscopy

No	Sex	Age (yr)	Indication	Post surgical anatomy	Findings	Intervention
1	Male	55	Jaundice	s/p Whipple with Roux-en-Y HJ	A1	Stenting
						Stent extraction and new stent (× 2)
						Balloon dilation
2	Male	55	Cholestasis, jaundice	s/p Whipple with Roux-en-Y HJ	A1	Cannulation with Jagwire
						Cholangiogram
						Stenting
3	Female	78	Upper GI-bleeding, melena, suspicious bleeding from the afferent loop	s/p Roux-en-Y HJ after complicated CCE	B	Direct endoscopic cholangiogram
						APC-therapy of angiodysplasias at the HJ
4	Male	36	Cholestasis, recurrent cholangitis	s/p Whipple with Roux-en-Y HJ	A2	Cholangiogram
						Stent placement
						Stone extraction
5	Male	69	Jaundice, suspicious relapse of Klatskin-Tumor	s/p partial CBD resection with hepaticojejunostomy	NA	Tumor biopsies at the HJ
						Cannulation failed
						=> PTCD
6	Male	70	Cholestasis	s/p Whipple’s operation, Roux-en-Y HJ	A1	Cholangiogram
						Stent insertion
7	Male	77	Cholestasis	s/p partial gastric resection with Roux-en-Y HJ	A2	Cannulation with Jagwire
						Cholangiogram
				s/p PTCD		DHC-stenosis
						No stent
8	Male	72	Cholangitis	s/p Roux-en-Y HJ	NA	Failed (adhesions)
9	F	36	Cholestasis, chronic abdominal pain	s/p Roux-en-Y HJ	A1	Cholangiogram
						Balloon dilatation
						Perforation
10	Male	36	Cholestasis	s/p at age of 17 with Roux-en-Y HJ	B3	Referred for OLT
				Late onset ulcerative colitis
11	Male	65	Choledocolithiasis, abdominal pain, cholestasis	s/p Whipple’s operation, Roux-en-Y HJ	A1	Balloon dilation and stenting
						Stent and stone extraction
12	Female	25	Cholangitis	s/p at age of 3 resection of a choledococele with Roux-en-Y HJ	A1	Bougienage of CBD stenosis and stent (× 2) insertion
						Stent retrieval and balloon dilation of CBD stenosis
13	Female	75	Choledocolithiasis	s/p Roux-en-Y HJ after complicated CCE (iatrogenic bile duct injury)	NA	Failed, adhesions, afferent limb intubated but proximal end not reached and HJ not found
14	Male	70	Cholestasis	s/p Whipple’s operation, Roux-en-Y HJ	B1	Failed, oxygen desaturation
						Cholangiogram, biliary stent insertion
15	Male	72	Cholangitis	s/p Roux-en-Y with HJ after a complicated CCE (gangrenous cholecystitis)	A2	Dilation of CBD stenosis
						Biliary stent insertion
16	Male	54	Choledocolithiasis	s/p partial gastric resection with Roux-en-Y HJ	A2	Dilation of CBD stenosis, stent insertion
						Stone extraction
17	Female	58	Choledocolithiasis	s/p Whipple’s operation, Roux-en Y HJ	NA	Failed, adhesions, afferent limb intubated but proximal end not reached and HJ not found
18	Male		Jaundice	s/p Whipple’s operation, Roux-en Y HJ	A1	Dilatation
						Stenting

HJ: Hepaticojejunostomy; GI: Gastrointestinal; CBD: Common bile duct; CCE: cholecystectomyPTCD: Percutaneous transhepatic cholangiography drainage; DHC: ductus hepaticus communis; OLT: Orthotopic liver transplantation; s/p: Status post; NA: Not applicable.

Table 2 Endoscopic-cholangiographic classification of hepaticojejunostomies

Type	Endoscopic findings
A	Small opening
B	Large opening
C	Normal opening
D	Double opening (i.e., double anastomosis)
S	Supra-anastomotic stricture1
	Cholangiographic findings
0	No stricture
1	Short stricture
2	Long stricture
3	Intrahepatic strictures

Letters refer to endoscopic appearance and numerals refer to cholangiographic characteristics.

¹In cases of normal (B) or large opening (C) a supra-anastomotic stricture can be present. This is separately indicated by S.