Use of peripheral cutting balloon in the management of resistant benign ureteral and biliary strictures

PURPOSE: To report the initial and midterm results of percutaneous cutting balloon incision and dilation (PCBID) for the treatment of benign ureteral and biliary strictures in patients after failed high-pressure balloon dilation. MATERIALS AND METHODS: The study sample consisted of 11 patients: three with ureteric strictures after renal transplantation, three with biliary anastomotic strictures after liver transplantation, three with pelvic metastatic disease compressing the ureter, one after a failed endoscopic papilla of Vater sphincterotomy, and one with tight stenosis at the choledochojejunal anastomosis. All strictures were resistant to high-pressure balloon dilation. Four patients underwent PCBID immediately after failed high-pressure balloon dilation in the same session, and seven underwent the procedure in a separate session within the subsequent week. The width of the peripheral cutting balloons did not exceed the diameter of the normal lumen (7-8 mm). RESULTS: PCBID was successful in nine patients (82%). One failure occurred in a transplanted ureter and one occurred in a transplanted liver with a choledochocholedochal anastomosis. In both cases, PBCID was performed in the same session as failed high-pressure balloon dilation. There were no periprocedural complications. Patency was confirmed at the 3- and 6-month clinical and ultrasonographic follow-up. CONCLUSION: PCBID is a simple minimally invasive method for the treatment of benign ureteric and biliary strictures. The success rate is high and no complications occurred.