Coronary balloon angioplasty for severe biliary strictures: a novel endoscopic approach

Czech version

Authors: G. R. Sivandzadeh ¹; S. A. Taghavi ¹; M. Tahani ²; F. Sharafi ²; I. Shahramian ¹
Authors‘ workplace: Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran ¹; Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran ²
Published in: Gastroent Hepatol 2025; 79(6): 473-477
Category: Clinical and Experimental Gastroenterology: Review Article

Overview

:Severe biliary strictures present a substantial challenge in endoscopic interventions, often resistant to conventional dilation techniques. This case series explores the successful utilization of coronary angioplasty balloons, typically reserved for cardiovascular applications, in six patients with tight biliary strictures where standard through-the-scope (TTS) balloons failed. The patients, ranging from pediatric to adult cases, exhibited diverse etiologies, including post-transplant and chronic inflammatory strictures. Results demonstrated the versatility and efficacy of coronary balloons, achieving complete biliary flow restoration without complications. This study highlights the potential of coronary balloon angioplasty as an indispensable tool for complex endoscopic retrograde cholangiopancreatography (ERCP) procedures. These findings support the broader adoption of this technique and warrant further investigations through larger clinical studies.

Keywords:

ERCP – coronary balloon – biliary stenting – severe biliary strictures – endoscopic dilation – case series

Sources

1. Simons-Linares CR, O’Shea R, Chahal P. Severe primary sclerosing cholangitis biliary stricture managed with a small-caliber cardiac angioplasty balloon: looking outside the endoscopic retrograde cholangiopancreatography toolbox. ACG Case Rep J 2019; 6 (7): e00141. doi: 10.14309/crj.0000000000000141.

2. Li C, Gong J, Huang W et al. A novel technique of percutaneous transhepatic treatment of biliary-enteric anastomotic occlusive strictures with compliant balloon-occluded cholangiography and large-bore catheter: a retrospective case series. Quant Imaging Med Surg 2024; 14 (5): 3572–3580. doi: 10.21037/qims-23-1693.

3. Kawakami H, Kubota Y, Ashizuka S et al. Balloon enteroscopy-assisted biliary drainage using a diathermic dilator followed by placement of a novel ultra-slim metallic stent. Endoscopy 2017; 49 (Suppl 1): E78–E80. doi: 10.1055/ s-0042-124499.

4. Pereira GB, Gutierrez JP, D’Assuncao M et al. Utility of a stent pusher catheter as a “mini-overtube” in the endoscopic management of post-liver transplant biliary strictures. Endoscopy 2015; 47 (Suppl 1): E587–E589. doi: 10.1055/s-0034-1393386.

5. Huszar O, Szijarto A, Tihanyi T et al. A novel percutaneous transhepatic treatment of a benign bile duct stricture –⁠ a pilot study. Croat Med J 2019; 60 (5): 397–404. doi: 10.3325/cmj.2019. 60.397.

6. Lee JH, Kim DU, Han SY et al. Use of a cutting balloon dilation as a rescue therapy in patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation. Korean J Pancr Biliary Tract 2022; 27 (3): 128–134. doi: 10.15279/kpba.2022.27.3.128.