Endoscopic Intervention and Surgical Treatment of Benign Biliary‐Enteric Anastomotic Stricture: Real‐World Clinical Impact

OBJECTIVES: Although endoscopic interventions and surgery are both used for treating bening biliary-enteric anastomotic stricture (BEAS), their comparative efficacy, safety, and economic impact have not been established. We conducted this study to address that gap. METHODS: Patients who underwent endoscopic intervention or surgical treatment for benign BEAS at Changhai Hospital, The First Affiliated Hospital of Naval Medical University (Shanghai, China) from February 2013 to February 2024 were included. The primary end-point was stricture resolution rate. Secondary end-points included adverse events (AEs), length of hospital stay, and total hospitalization cost. RESULTS: There were 65 and 58 patients underwent endoscopic intervention and surgical treatment for benign BEAS, respectively. The stricture resolution rate was lower in the endoscopic intervention group than in the surgical treatment group (78.5% vs. 93.1%, p = 0.024); however, endoscopic intervention achieved an ultimate stricture resolution rate of 90.8%. Endoscopic intervention had significantly lower rates of overall AE (9.2% vs. 27.6%, p = 0.01) and early AE (occurred within 30 days after surgery/endoscopic intervention) (4.6% vs. 25.9%, p = 0.002). In addition, endoscopic intervention resulted in a shorter length of hospital stay (10 days vs. 13 days, p = 0.013) and a lower hospitalization cost (CNY 24 355 vs. CNY 35 663, p < 0.001). CONCLUSIONS: In benign BEAS, surgery achieved a higher stricture resolution rate, whereas endoscopic intervention offered superior short-term outcomes, including shorter hospital stay, lower costs, and fewer AEs. Hence, we recommend initial endoscopic intervention with surgery reserved for nonresponders and recurrent cases.