A Prospective Study of Standardized Nonsurgical Therapy in the Management of Biliary Anastomotic Strictures Complicating Liver Transplantation

Holt, Andrew; Thorburn, Douglas; Mirza, D.; Gunson, Bridget K.; Wong, Terry; Haydon, Geoffrey

doi:10.1097/01.tp.0000282805.33658.ce

Cited by 106 publications

(72 citation statements)

References 20 publications

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“…Even 1 week before ERC diagnosis of AS, 96% of patients revealed a normal ultrasound (9). However, in a newer series 92% of patients with biliary complications revealed ultrasound abnormalities (10). Hepatic artery thrombosis (HAT)-or stenosis is excluded by additional Doppler examination.…”

Section: Diagnosis Of Biliary Complicationsmentioning

confidence: 99%

“…Early conversion to surgical therapy is indicated, since delay might be accompanied with persistent allograft dysfunction (45). In the long term, about 10-20% of patients with AS require surgical revision (10,18), mainly in the form of bilioenteric anastomosis (46,47). In most centers surgical treatment is regarded as second-line therapy and it has been shown, that previous failure of interventional therapy does no negatively affect the outcome after 'second-line' surgical reconstruction (48).…”

Section: Therapy Of Anastomotic Stenosismentioning

confidence: 99%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

252

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Diagnosis Of Biliary Complicationsmentioning

confidence: 99%

Section: Therapy Of Anastomotic Stenosismentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

252

233

View full text Add to dashboard Cite

show abstract

“…It is also advised that balloon dilation should not be performed for very early strictures and for strictures in the setting of an anastomotic leak to prevent disintegration of biliary anastomosis. Severe complications of this technique are rare, although, a large study showed a complication rate of 6.6% per procedure which increases to 21% per patient as they get more than one procedure [41] . Some of the complications include pancreatitis, cholangitis, stent migration and hemorrhage.…”

Section: Biliary Stricturesmentioning

confidence: 99%

Endoscopic management of post-liver transplant biliary complications

Girotra¹,

Soota²,

Klair³

et al. 2015

WJGE

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Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques that have proved endoscopic retrograde cholangiography with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also discuss the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality. Core tip: Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques which have proved ERCP with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also deliberate the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality.

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“…The first plastic stent can be inserted either transhepatically or by a rendezvous transpapillary technique. The disadvantage of the single transhepatic technique is that it does not enable to insert multiple stents in one session (Holt et al, 2007;Pasha et al, 2007;Kulaksiz et al, 2008). …”

Section: Anastomotic Stricturesmentioning

confidence: 99%

Biliary Complications After Liver Transplantation

Špičák¹,

Bartakova²

2012

Liver Transplantation - Technical Issues and Complications

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A Prospective Study of Standardized Nonsurgical Therapy in the Management of Biliary Anastomotic Strictures Complicating Liver Transplantation

Abstract: Endoscopic balloon dilatation and stenting is a safe and effective means of treating biliary anastomotic strictures complicating liver transplantation.

Cited by 106 publications

References 20 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Endoscopic management of post-liver transplant biliary complications

Biliary Complications After Liver Transplantation

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