Successful Biliary Re-Cannulation and Neo-Anastomosis Creation in Complete Bile Duct Occlusion or Disruption Using a Combination of Interventional Radiology and Endoscopic Techniques

Authors

• Joshua G. Fricker, University of Alabama at BirminghamFollow
• Tarik Babar, Division of Vascular and Interventional Radiology
• Husameddin El Khudari, Division of Vascular and Interventional Radiology
• Ali Ahmed, University of Alabama at Birmingham
• Dalton Norwood, University of Alabama at Birmingham
• Sergio A. Sánchez-Luna, University of Alabama at Birmingham
• Eric Bready, Division of Vascular and Interventional Radiology
• Ramzi Mulki, University of Alabama at Birmingham
• Kondal Kyanam, University of Alabama at Birmingham
• Shajan Peter, University of Alabama at Birmingham
• Andrew Gunn, University of Kentucky

Abstract

Aims: Biliary strictures are a known complication of hepatobiliary and pancreatic surgeries. This retrospective descriptive series highlights six consecutive patients with complete bile duct occlusion or disruption who required a multidisciplinary approach with a combination of interventional radiology (IR) and endoscopic techniques to either re-cannulate or create a neo-anastomosis in the biliary system. Methods and Results: The biliary system was either re-cannulated or a neo-anastomosis was created using a small gauge needle (N = 3), a rendezvous procedure (N = 1), a radiofrequency ablation wire (N = 1), and the back end of a wire (N = 1). There was one major adverse event (bacteremia requiring antibiotic therapy). Follow-up protocol included scheduled biliary catheter checks every 10–12 weeks to assess biliary duct patency or tract maturation. At each interval, cholangioscopy and cholangioplasty were performed as indicated. Once the tract demonstrated maturity and liver function tests normalized, the catheter was converted to an external-only drain. Patients who successfully tolerated a capping trial of the external biliary catheter subsequently underwent catheter removal. Patients who remained asymptomatic with normal liver function tests following catheter removal were considered to have achieved catheter-free status. Conclusion: Four of the six patients are biliary catheter free, while two of the patients are progressing toward being catheter free. Additional data from larger series and planned prospective registries should help delineate standards for outcomes and patient management.

Document Type

Article

Publication Date

2-1-2026

Notes/Citation Information

Publisher Copyright: © 2026 The Author(s). JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Digital Object Identifier (DOI)

10.1002/jgh3.70278

Archival?

Archival

Repository Citation

Fricker, Joshua G.; Babar, Tarik; El Khudari, Husameddin; Ahmed, Ali; Norwood, Dalton; Sánchez-Luna, Sergio A.; Bready, Eric; Mulki, Ramzi; Kyanam, Kondal; Peter, Shajan; and Gunn, Andrew, "Successful Biliary Re-Cannulation and Neo-Anastomosis Creation in Complete Bile Duct Occlusion or Disruption Using a Combination of Interventional Radiology and Endoscopic Techniques" (2026). Radiology Faculty Publications. 48.
https://uknowledge.uky.edu/radiology_facpub/48