Bile cast syndrome: Diagnosis and management, a case series

Abstract

Background and study aims Bile cast syndrome (BCS) is a complication of orthotopic liver transplantation (OLT). It occurs in 4 % to 18 % of OLT recipients and can present as cholangitis and graft damage or loss. Twenty-two percent of patients with BCS require repeat OLT. The diagnosis and management of BCS can be challenging. Our aim is to share our experience with BCS and to briefly review the diagnosis and management of the condition.

A Case of Biliary Cast Syndrome with Cholangiocarcinoma-like Lesion in a Patient with No History of Liver Transplantation

“…It is commonly managed through a combination of medical and interventional methods. Endoscopic or percutaneous interventions are frequently employed to remove biliary casts, improve bile flow surgically, or perform hepatic lobe resection or liver transplantation when necessary [1,3,4,6,7,9,[11][12][13].…”

“…The symptoms of biliary cast syndrome are mainly caused by cholangitis due to the blockage of the bile ducts. Rarely, bile duct obstruction test results are elevated without clear symptoms of cholangitis [ 11 ]. The symptoms of cholangitis were unclear in the patient in this case report.…”

“…It is commonly managed through a combination of medical and interventional methods. Endoscopic or percutaneous interventions are frequently employed to remove biliary casts, improve bile flow surgically, or perform hepatic lobe resection or liver transplantation when necessary [ 1 , 3 , 4 , 6 , 7 , 9 , 11 , 12 , 13 ]. In the case of this patient with a history of total gastrectomy, percutaneous intervention was undertaken to establish percutaneous biliary drainage, followed by multiple procedures for the removal of stones.…”

Delayed Expulsion of biliary cast after hepaticojejunostomy for post‐liver transplantation biliary stricture—better cut than canulate?

“…1 Percutaneous transhepatic choledochoscopy route on its own or in combination with endoscopic therapy has also been reported to be effective for accessing and clearing the casts. 4,5 We however believe that in selected patients with anastomotic strictures and associated BCS, an early decision favoring surgical management will ensure excellent biliary…”

Percutaneous Hepatobiliary Endoscopy in the Interventional Radiology Suite

“…3 The same toolkit of devices used for stones may also be used to treat biliary casts and sludge. 12 Clam shell forceps are used for tissue biopsy. 3 Biliary strictures at the choledochojejunostomy anastomosis as well as elsewhere may be characterized visually and treated with radiofrequency wire ablation and Holmium laser ablation.…”