Percutaneous balloon dilation for benign postoperative biliary strictures: comparison of bilioenteric and non-bilioenteric anastomotic strictures

Percutaneous transhepatic therapy has been increasingly used to treat benign postoperative biliary strictures (PBS), particularly in cases where endoscopy has failed or is not feasible. We evaluated the safety, efficacy and hospitalisation costs of percutaneous balloon dilation for PBS and compared outcomes between bilioenteric anastomotic strictures (BAS) and non-BAS. This retrospective cohort study analysed patients with benign PBS who underwent balloon dilation between May 2012 and February 2025. A total of 94 patients were enrolled: 52 with BAS (group A) and 42 with non-BAS (group B). Following balloon dilation (4–12 mm), percutaneous transhepatic biliary drainage was performed using an 8.5- to 10.2-F internal–external biliary drainage tube. Drainage tubes were replaced every 4–8 weeks, with repeat balloon dilation of the stricture performed as needed. A total of 210 dilations were performed in 94 patients, with technical success rates per procedure of 97.8% in group A and 94.7% in group B. The average number of dilations in group A was significantly higher than in group B ( P = 0.0349). The total number of hospitalisations was higher in group A than in group B, although the difference was not statistically significant. The median indwelling duration of drainage tubes was 9.1 months in group A and 9.8 months in group B. Drainage tube migration or obstruction was the most common complication in both groups. Ten patients were converted from percutaneous treatment to surgical intervention. The 1-, 3- and 5-year patency rates were 92.0%, 80.6% and 76.7% in group A, respectively, compared with 95.0%, 92.1% and 92.1% in group B, respectively ( P = 0.0842). Excluding three cases lost to follow-up, 50 patients (53.2%) were cured, while 18 patients (19.1%) showed clinical improvement, resulting in an overall clinical success rate of 72.3%. This study demonstrated that percutaneous balloon dilation may be safe and effective in this selected cohort of patients with benign PBS. BAS was associated with a higher number of balloon dilation procedures than non-BAS. However, these findings should be validated through prospective or multicentre studies.