Safety and Feasibility of Antegrade Cholangiopancreatoscopy‐Guided Laser Dissection and Ablation for Pancreaticobiliary Jejunal Anastomotic Stricture (With Video)

Hepaticojejunostomy anastomotic stricture (HJS) and pancreaticojejunostomy anastomotic stricture (PJS) are late adverse events that can occur after pancreaticoduodenectomy. Although endoscopic and percutaneous interventions are available, recurrence remains common because of residual fibrotic tissue. Cholangiopancreatoscopy-guided laser dissection or ablation (CPL) has been reported for benign pancreatobiliary strictures; however, evidence regarding antegrade CPL for HJS/PJS is limited. This study aimed to evaluate the safety and feasibility of antegrade CPL for HJS/PJS. This retrospective study included consecutive patients with HJS or PJS who underwent antegrade CPL. The primary outcome was the incidence of adverse events related to antegrade CPL. Antegrade CPL was performed in 19 patients after exclusion of 1 malignant stricture. Technical success was achieved in all cases. Mean procedure time was 21 min. Complete stricture resolution was observed in 73.7% of patients, and partial resolution in 26.3%. Contrast passage from the duct to the intestine was confirmed in all patients after CPL. Antegrade CPL for HJS/PJS showed a favorable short-term safety profile, with no severe CPL-related adverse events, while maintaining technical feasibility and achieving endoscopic stricture resolution in all treated patients. Further prospective studies with longer follow-up are warranted to confirm its safety and durability.