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    J Korean Soc Radiol. 2013 Apr;68(4):305-313. Korean.
    Published online Apr 10, 2013.
    https://doi.org/10.3348/jksr.2013.68.4.305
    Copyright © 2013 The Korean Society of Radiology
    Original Article

    Percutaneous Balloon Dilatation and Catheter Maintenance Method in the Patients with Biliary Strictures after Living Donor Liver Transplantation

    Dae Hong Park, MD,1 Sung Su Byun, MD,1 Jeong Ho Kim, MD,1 Keon Kuk Kim, MD,2 Hee Young Hwang, MD,1 Hyung Sik Kim, MD,1 Hye-Young Choi, MD,1 and Jae Hyung Park, MD1
      • 1Department of Radiology, Gachon University School of Medicine, Gil Hospital, Incheon, Korea.
      • 2Department of General Surgery, Gachon University School of Medicine, Gil Hospital, Incheon, Korea.
    • Corresponding author: Sung Su Byun, MD. Department of Radiology, Gachon University School of Medicine, Gil Hospital, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea. Tel. 82-32-460-3062, Fax. 82-32-460-3065, Email: radbyun@hanmail.net
    Received January 06, 2013; Accepted January 25, 2013.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    The aim of this study was to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and catheter maintenance (BDCM) method for postoperative biliary strictures following living donor liver transplantation (LDLT).

    Materials and Methods

    Eighteen patients (14 duct-to-duct anastomosis and 4 hepaticojejunostomy) with post-LDLT biliary stricture were treated by the percutaneous BDCM method. A good response was defined as residual stricture over 3.5 mm after repetitive BDCM and refractory response as residual stricture below 3.5 mm. If they demonstrated good results on follow-up studies after catheter withdrawal, all the patients quit the therapy. We evaluated the technical and clinical success rates, major complication rate, mean total procedure time and mean follow-up duration.

    Results

    The percutaneous BDCM method was technically successful without major complication. Nine patients improved biliary stricture (good response, mean 5.5 mm), and the other 9 patients showed residual stricture with the diameter below 3.5 mm (refractory response, mean 2.5 mm). However, all the patients were improved clinically without significant complication. The total procedure time was 1-15 months (mean 7.3 months) and follow-up duration was 6-54 months (mean 24 months).

    Conclusion

    The percutaneous BDCM method for post-LDLT biliary strictures was an effective therapy even in the patients showing a refractory response. It seemed that total procedure time could be reduced if the response was determined earlier.

    Keywords
    Living Donor Liver Transplantation; Biliary Stricture; Percutaneous Balloon Dilatation; Catheter Maintenance

    Figures

    Fig. 1
    Flow diagram showing the percutaneous balloon dilatation and catheter maintenance method following living donor liver transplantation.

    Note.-BDCM = balloon dilatation and catheter maintenance, F/U = follow-up, PTBD = percutaneous transhepatic bile drainage

    Fig. 2
    A 44-year-old male who underwent living donor liver transplantation with duct-to-duct anastomosis.

    A. The cholangiography obtained during transhepatic insertion of a biliary drainage catheter shows biliary anastomotic occlusion (arrow).

    B. Follow-up cholangiogram after 6 mm diameter balloon dilatation and 10.2-Fr internal-external biliary drainage catheter maintenance during 2 weeks shows improvement of biliary stricture but residual biliary anastomotic stricture (arrow). The minimum diameter of residual stricture is 3.2 mm.

    C. Follow-up cholangiogram after 8 mm diameter balloon dilatation and 10.2-Fr internal-external biliary drainage catheter maintenance during 4 weeks shows residual biliary anastomotic stricture (arrow). The minimum diameter of residual stricture is 3.8 mm.

    D. Follow-up cholangiogram after 6 mm diameter balloon dilatation and 12-Fr internal-external biliary drainage catheter maintenance during 8 weeks shows patent bile duct with excellent flow of contrast medium into the duodenal loop. The minimum diameter of residual stricture is 6.7 mm. And then the catheter was removed (good response group).

    Fig. 3
    A 49-year-old male who underwent living donor liver transplantation with duct-to-duct anastomosis.

    A. Percutaneous transhepatic cholangiogram shows complete occlusion at the biliary anastomotic site (arrow).

    B. Follow-up cholangiogram obtained during the second balloon dilatation procedure after 6-Fr internal-external biliary drainage catheter maintenance for 4 weeks shows improvement of biliary stricture with passing the 8.5-Fr pigtail catheter through the stricture site. However, residual biliary anastomotic stricture (arrow) was till noted. The minimum diameter of residual stricture is 3.2 mm.

    C. A cholangiogram 9 months after the positioning of a pigtail catheter through the stricture site with 5 times balloon dilatations shows restenosis at the anastomotic site (arrow). The minimum diameter of residual stricture is 2.0 mm. But the flow of contrast medium into the duodenal loop is excellent (not shown). So the catheter was removed (refractory group).

    Tables

    Table 1
    Demographic Data of 18 Patients

    Table 2
    Clinical Data and Results of the Balloon Dilatation and Catheter Maintenance Method Following Liver Transplantation

    Table 3
    Comparison According to the Biliary Reconstruction Procedure

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    MeSH Terms
    Catheters
    Constriction, Pathologic
    Dilatation
    Follow-Up Studies
    Humans
    Liver
    Liver Transplantation
    Living Donors
    Metrics
    Share
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