An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications

Abstract

Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiodrainage in biliary strictures after liver transplantation: Long‐term outcome predictors and influence on patient survival

“…In the NAS group receiving ERC only, a higher number of ERC sessions were significantly associated with treatment success. Since PTCD is typically indicated in patients with BDA and as alternative treatment after unsuccessful ERC, the higher average number of percutaneous interventions most likely reflects the complexity of these biliary strictures. However, in the present study treatment with ERC alone compared to PTCD (with or without additional ERC) was not significantly associated with success in patients with any stricture type.…”

“…Biliary tract complications represent the most frequent complications in patients after orthotopic liver transplantation (OLT) . They include anastomotic strictures (AS), nonanastomotic strictures (NAS), biliary leak, cast/stone formation and papillary stenosis . Of these, biliary strictures represent the most common biliary complications .…”

“…Of these, biliary strictures represent the most common biliary complications . Interventional endoscopic retrograde cholangiography (ERC) with balloon dilatation and/or stent placement represents nowadays the standard treatment in many centres . If ERC fails or is not feasible due to a primary biliodigestive anastomosis (BDA), percutaneous transhepatic biliary drainage (PTCD) serves as an alternative treatment approach to avoid surgery …”

Large-duct cholangiopathies: aetiology, diagnosis and treatment

“…Biliary complications of liver transplantation are not uncommon and have been reported to occur in 15%–40% of transplants 36. Strictures following orthotopic liver transplantation can occur at the biliary anastomosis or be more diffuse 34 37–40…”

Endoscopic Management of Biliary Complications after Liver Transplant

“…Factors contributing to post-LT biliary leakage include ischemic injury to hepatic artery, cystic duct leakage, partial or full anastomotic site disruption, and cut surface leakage in LDLT. 25,37,38 Leaks may be extrahepatic or intrahepatic with extravasation into the hepatic parenchyma. The onset of biliary leak can occur immediately after transplant to 6 months after transplant.…”