Hepatobiliary scintigraphy in the assessment of bile outflow in patients with biliodigestive anastomosis

Aim. To determine the character of bile outflow in patients who underwent biliary tract reconstructive surgery without any clinical and instrumental evidence of the stricture of biliodigestive anastomosis.

Materials and methods. The authors analyzed the findings of radionuclide biliary tract studies conducted in 102 patients with biliodigestive anastomosis from 2016 to 2020. The significant relationship between clinical data and hepatobiliary scintigraphy results was confirmed using Fisher’s exact test.

Results. In 75 patients (73.5%), bile outflow disturbance was attributed to the efferent loop motility. Of these cases, 3 (4%) involved paresis of the efferent loop, while 70 (93.3%) exhibited multiple episodes of reflux from the efferent loop into the biliodigestive anastomosis and the intrahepatic bile ducts. In 2 patients (2.6%) showing no clinical signs of chronic cholangitis, a rare reflux from the efferent loop into the biliodigestive anastomosis and the intrahepatic bile ducts was noted.

Conclusions. Efferent loop dysfunction can greatly disturb bile outflow following the formation of a biliodigestive anastomosis, thus creating conditions for the development of complications.

1. Briskin B.S., Titova G.P., Ektov P.V., Klimenko Yu.F. A new perspective on the structure of the closure mechanism of the terminal common bile duct. Аnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2003; 8 (1): 63–71. (In Russian)

2. Okabayashi T., Shima Y., Sumiyoshi T., Sui K., Iwata J., Morita S., Iiyama T., Shimada Y. Incidence and risk factors of cholangitis after hepaticojejunostomy. J. Gastrointest. Surg. 2018; 22 (4): 676–683. https://doi.org/10.1007/s11605-017-3532-9

3. Eldredge T.A., Bills M., Myers J.C., Bartholomeusz D., Kiroff G.K., Shenfine J. HIDA and seek: challenges of scintigraphy to diagnose bile reflux post-bariatric surgery. Obes. Surg. 2020; 30 (5): 2038–2045. https://doi.org/10.1007/s11695-020-04510-7

4. Matesan M., Bermo M., Cruite I., Shih C.H., Elojeimy S., Behnia F., Lewis D., Vesselle H. Biliary leak in the postsurgical abdomen: a primer to HIDA scan interpretation. Semin. Nucl. Med. 2017; 47 (6): 618–629. https://doi.org/10.1053/j.semnuclmed.2017.06.002

5. Karmazanovsky G.G. The role of MDCT and MRI in the diagnosis of focal liver diseases. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2019; 24 (4): 91–110. https://doi.org/10.16931/1995-5464.2019491-110 (In Russian)

6. Kulezneva Yu.V., Melekhina O.V., Kurmanseitova L.I., Efanov M.G., Tsvirkun V.V., Alikhanov R.B., Patrushev I.V. X-ray surgical treatment of benign strictures of biliodigestive anastomosis: questions for discussion. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017; 22 (3): 45–54. https://doi.org/10.16931/1995-5464.2017345-54 (In Russian)

7. Krishnamurthy G.T., Krishnamurthy Sh. Nuclearhepatology. London – New York: Springer Dordrecht Heidelberg, 2009. 363 p. https://doi.org/10.1007/978-3-642-00648-7

8. Kudryashova N.Y., Yermolov A.S., Migunova E.V., Sinyakova O.G., Gurok E.A. Scintigraphy in urgent conditions and complications of acute diseases and traumas. Russian Sklifosovsky Journal “Emergency Medical Care”. 2014; 2: 14–19. (In Russian)

9. Birgin E., Téoule P., Galata C., Rahbari N.N., Reissfelder C. Cholangitis following biliary-enteric anastomosis: a systematic review and meta-analysis. Pancreatology. 2020; 20 (4): 736–745. https://doi.org/10.1016/j.pan.2020.04.017

10. Hanau L.H., Steigbigel N.H. Acute (ascending) cholangitis. Infect. Dis. Clin. North Am. 2000; 14 (3): 521–546. https://doi.org/10.1016/s0891-5520(05)70119-7

11. Lubikowski J., Chmurowicz T., Post M., Jarosz K., Białek A., Milkiewicz P., Wójcicki M. Liver transplantation as an ultimate step in the management of iatrogenic bile duct injury complicated by secondary cirrhosis. Ann. Transpl. 2012; 17 (2): 38–44. https://doi.org/10.12659/aot.883221

12. Said A., Safdar N., Lucey M.R., Knechtle S.J., D'Alessandro A., Musat A., Pirsch J., Kalayoglu M., Maki D.G. Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention. Am. J. Transplant. 2004; 4 (4): 574–582. https://doi.org/10.1111/j.1600-6143.2004.00374.x

13. Hakamada K., Sasaki M., Endoh M., Itoh T., Morita T., Konn M. Late development of bile duct cancer after sphincteroplasty: a ten- to twenty-two-year follow-up study. Surgery. 1997; 121 (5): 488–492. https://doi.org/10.1016/s0039-6060(97)90101-x

14. Tocchi A., Mazzoni G., Liotta G., Lepre L., Cassini D., Miccini M. Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients. Ann. Surg. 2001; 234 (2): 210–214. https://doi.org/10.1097/00000658-200108000-00011

15. Costamagna G., Boškoski I. Current treatment of benign biliary strictures. Ann. Gastroenterol. 2013; 26 (1): 37–40.

16. Le Blanc-Louvry I., Ducrotté P., Manouvrier J.L., Peillon C., Testart J., Denis P. Motility of the Roux-en-Y hepaticojejunostomy in asymptomatic patients. Am. J. Gastroenterol. 1999; 94 (9): 2501–2508. https://doi.org/10.1111/j.1572-0241.1999.01384.x

17. Johnson C.P., Sarna S.K., Cowles V.E., Osborn J.L., Zhu Y.R., Bonham L., Buchmann E., Baytiyeh R., Telford G.L., Roza A.M., Adams M.B. Motor activity and transit in the autonomically denervated jejunum. Am. J. Surg. 1994; 167 (1): 80–88. https://doi.org/10.1016/0002-9610(94)90057-4

18. Ducrotte P., Peillon C., Guillemot F., Testart J., Denis P. Could recurrent cholangitis after Roux-en-Y hepaticojejunostomy be explained by motor intestinal anomalies? A manometric study. Am. J. Gastroenterol. 1991; 86 (9): 1255–1258.

19. Kuchumov А.G., Gilev V.G., Popov V.A., Samartsev V.A., Gavrilov V.A. Experimental investigation of the pathologic bile Rheology. Russian Journal of Biomechanics. 2011; 15 (3) (53): 52–60. (In Russian)

20. Koutelidakis I., Papaziogas B., Giamarellos-Bourboulis E.J., Makris J., Pavlidis T., Giamarellou H., Papaziogas T. Systemic endotoxaemia following obstructive jaundice: the role of lactulose. J. Surg. Res. 2003; 113 (2): 243–247. https://doi.org/10.1016/s0022-4804(03)00209-9

21. Sato K., Hall C., Glaser S., Francis H., Meng F., Alpini G. Pathogenesis of Kupffer cells in cholestatic liver injury. Am. J. Pathol. 2016; 186 (9): 2238–2247. https://doi.org/10.1016/j.ajpath.2016.06.003

22. Hyun J.J., Yeom S.K., Shim E., Cha J., Choi I., Lee S.H., Chung H.H., Cha S.H., Lee C.H. Correlation between bile reflux gastritis and biliary excreted contrast media in the stomach. J. Comput. Assist. Tomogr. 2017; 41 (5): 696–701. https://doi.org/10.1097/RCT.0000000000000585

23. Tatsugami M., Ito M., Tanaka S., Yoshihara M., Matsui H., Haruma K., Chayama K. Bile acid promotes intestinal metaplasia and gastric carcinogenesis. Cancer Epidemiol. Biomarkers Prev. 2012; 21 (11): 2101–2107. https://doi.org/10.1158/1055-9965.EPI-12-0730

24. Li D., Zhang J., Yao W.Z., Zhang D.L., Feng C.C., He Q., Lv H.H., Cao Y.P., Wang J., Qi Y., Wu S.R., Wang N., Zhao J., Shi Y.Q. The relationship between gastric cancer, its precancerous lesions and bile reflux: a retrospective study. J. Dig. Dis. 2020; 21 (4): 222–229. https://doi.org/10.1111/1751-2980.12858

25. Dzhulay G.S., Sekareva E.V. Gastric and duodenal secretory and motor-evacuatory activity in patients with gastroesophageal reflux disease associated with different types of reflux. Terapevticheskii Arkhiv. 2016; 88 (2): 16–20. https://doi.org/10.17116/terarkh201688216-20 (In Russian)