Peroral cholangioscopy-guided laser-stricturoplasty for intrahepatic benign biliary strictures (with video) - 04/12/25

Doi : 10.1016/j.gie.2025.10.024

Yusuke Takasaki, MD, PhD ¹, Hiroyuki Isayama, MD, PhD ^1,^2,^⁎ , Yusuke Yamaguchi, MD ¹, Haruka Hagiwara, MD ¹, Fumi Kurata, MD ¹, Ippei Ikoma, MD ¹, Yasuhisa Jimbo, MD ¹, Muneo Ikemura, MD ¹, Tomoya Takahashi, MD ¹, Sho Takahashi, MD, PhD ¹, Ko Tomishima, MD, PhD ¹, Shigeto Ishii, MD, PhD ³, Toshio Fujisawa, MD, PhD ¹

¹ Department of Gastroenterology, Graduate School of Medicine, University of Juntendo, Tokyo, Japan

² Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand

³ Department of Gastroenterology, Juntendo Nerima hospital, Tokyo, Japan

^∗ Corresponding author: Hiroyuki Isayama, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan 113-8421. Department of Gastroenterology Graduate School of Medicine Juntendo University 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421 Japan

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 04 December 2025

Abstract

Background and Aims

Endoscopic treatment of intrahepatic benign biliary strictures (BBSs) remains challenging despite repeated balloon dilation and long-term stent placement. The small-caliber, branching, and tortuous anatomy of intrahepatic ducts limits the feasibility of fully covered self-expandable metallic stents. Recently, endoscopic laser stricturoplasty (LAS) has emerged as a promising therapeutic option. We report a case series of 4 patients who underwent successful peroral cholangioscopy-guided LAS (POCS-LAS).

Methods

This retrospective pilot study was conducted at Juntendo University Hospital. Patients who underwent POCS-LAS for intrahepatic BBSs between December 2024 and June 2025 were reviewed to evaluate the feasibility and safety of the procedure.

Results

Six POCS-LAS sessions using a holmium:yttrium–aluminum–garnet laser were performed in 4 patients with postoperative intrahepatic BBS (2 choledochojejunostomies, 1 right hepatectomy, and 1 cholecystectomy). All procedures were performed with the patient under saline irrigation with a median duration of 100 minutes. Technical success, defined as successful passage of the POCS through the stricture, was achieved in all cases. No adverse events were reported. Three patients became stent-free, and 1 patient remains under treatment.