To investigate the clinical efficacy and safety of stepwise percutaneous cholangioscopy-guided laser technique for treating biliary-enteric anastomotic stricture after pancreaticoduodenectomy (PD).

Clinical data of 11 patients with biliary-enteric anastomotic stricture after PD who underwent treatment with stepwise percutaneous cholangioscopy-guided laser technique in the Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People′s Hospital Affiliated to Medical School of Westlake University from Jul. 2020 to Jun. 2025 were retrospectively analyzed. The puncture approach, interval time, number of procedures, operative time, intraoperative blood loss, and perioperative complications (including postoperative bile leakage and bleeding) were recorded and analyzed, along with long-term outcomes.

All 11 patients successfully completed the procedures without conversion to laparotomy. A right hepatic approach was used in 4 cases and a left hepatic approach in 7 cases. The median interval from puncture to operation was 7 days. The median operative time was 153 min, and the median intraoperative blood loss was 10 ml. Three patients underwent two-stage procedures. Postoperatively, fever occurred in 3 patients, no postoperative bleeding, bile leakage, or other complications were observed. The median postoperative bilirubin level was 21.3 μmol/L, and the median time to catheter removal was 7 days. During follow-up (median 24 months), no obvious abdominal pain or jaundice occurred, and no patient required readmission for reoperation.

With meticulous preoperative planning and refined operative technique, the stepwise percutaneous cholangioscopy-guided laser technique is safe and effective for treating biliary-enteric anastomotic stricture after PD, with no restenosis of the biliary-enteric anastomosis observed in long-term follow-up.