LiverComplicationEndoscopic Treatment of Bile Duct Complications After Orthotopic Liver Transplantation
Section snippets
Patients
In this retrospective study, we reviewed the data on all consecutive patients who underwent endoscopic treatment of biliary duct lesions after liver transplantation between 1998 and 2006. Orthotopic liver transplantation (OLT) recipients who underwent at least one ERCP were identified through an endoscopic computerized database. Indications, findings, and interventions performed during the exam were noted for each patient from the ERCP report. All other data, including the outcome of the
Results
Forty-two patients (mean age 50 years, range 13 to 65 years) underwent 58 ERCP (mean 1.38 sessions per patient) for biliary duct complications at a mean of 29 months after liver transplantation (range 0 to 133 months). Indications for ERCP were suspicion of bile duct stricture in 31, of bile duct stones in nine, or of bile leakage in two.
Papilla cannulation was possible in all but two patients (5%) who developed a spastic papilla. After entering the papilla, the choledochus was injected with
Discussion
Biliary duct lesions are the leading cause of surgical complications after liver transplantation, requiring in some cases biliary reconstruction by choledocho-choledocostomy or HJ.2 The diagnosis and treatment of these complications is performed more frequently by nonoperative approaches, than in the past namely percutaneous transhepatic cholangiography and ERCP. According to the results of this study, ERCP was a safe treatment modality, with a low risk of complications (2.4%) and an absence of
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Cited by (17)
Biliary complications after adult to adult right-lobe living donor liver transplantation (A-ARLLDLT): Analysis of 245 cases during 16 years period at a single high centre- A retrospective cohort study
2022, Annals of Medicine and SurgeryCitation Excerpt :Despite improved surgical techniques, perioperative care, organ preservation and immunosuppression in living donor liver transplantation(LDLT); biliary complications(BCs) (I.e. bile leaks, biliary strictures, cholangitis, biloma, cholangitic abscesses, bile duct stones/casts, ischemic biliary injury, hemobilia, sphincter of Oddi dysfunction(SOD), etc) remain a significant catastrophe after adult to adult right lobe LDLT (A-ARLLDLT) leading to post-transplant morbidities, dysfunctions and mortalities. [1,2] ; they may reach up to 60% of recipients [3–11]. They are related to various sources (i.e. Graft bile ducts (sizes, numbers and anatomic variations), biliary ischemic damage (hepatic artery complications, warm and cold ischemia times, ischemia-reperfusion injury (IRI), etc), biliary reconstruction related factors (reconstruction type and number, suture methods and materials and t-tube/stent use/non-use), immunologic issues (ABO incompatibility) and infections (biliary sepsis and cytomegalovirus (CMV) infections)) [1,12,13].
Plastic biliary stents for benign biliary diseases
2011, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :The majority of patients with anastomotic biliary strictures that occur after deceased-donor transplantation require several endoscopic interventions (on average between 1.6 and 6.0), with successful long-term clinical and morphologic resolution of the stricture between 70% and 100%. Recurrences have been variably reported in approximately 0% to 20% of cases, but can usually be managed conservatively by repeat endoscopic stent placment.33,40,41,67–69,71–77 The major disadvantages of endoscopic dilation of anastomotic strictures with plastic stents include the need for multiple procedures repeated over an extended period of time and the risk of cholangitis resulting from stent occlusion.
Does arterialisation time influence biliary tract complications after orthotopic liver transplantation?
2010, Transplantation ProceedingsCitation Excerpt :When cholangiography was not indicated, we explored the biliary system with biliary magnetic resonance imaging. The other possibility in cases of biliary anastomotic stenosis was to perform endoscopic retrograde cholangiopancreatography with a plastic or self-expandable metallic stent, or a self-expandable covered stent in cases of anastomotic leakage.2,3 A biliodigestive anastomosis was preferred when biliary stenosis occurred in the early postoperative period (within 3 weeks) or when conservative treatments had failed.
Early Regular Examination of Biliary Strictures by Endoscopic Retrograde Cholangiography for Duct-to-Duct Biliary Reconstruction After Adult Living Donor Liver Transplantation
2009, Transplantation ProceedingsCitation Excerpt :In our recent cases, 4/5 patients were treated without surgical reintervention. In any event of BS, obstruction, or leaks, ERC is the first-line diagnostic and/or therapeutic.4,5 The surgical consequence is derived from the severity and persistence of the obstruction.