Dilatation of biliary strictures through the afferent limb of a Roux-en-Y choledochojejunostomy in patients with sclerosing cholangitis

Repeated dilatation of biliary strictures in patients with sclerosing chola ngitis through a subcutaneously placed afferent limb of a choledochojejunos tomy is technically feasible and safe. This study is a prospective 15-year evaluation of 36 patients treated by repeat dilatation through this jejunal limb. There was one operative death and one major complication of dilatati on. The 5-year survival of all patients was 74%. If patients with cirrhosis or unproven cholangiocarcinoma at the time of operation are not included, the 5-year survival is 86%. The 15-year survival of all patients was 30%, i t was 64% if those with cirrhosis and unproven cholangiocarcinoma at the ti me of operation are not included. Six patients are presently alive with an average survival of 159 months. The study suggests that a combination of re peated dilatations combined with transplantation is the approach of choice in selected patients.