Biliary Stricture after Adult Right-Lobe Living-Donor Liver Transplantation with Duct-to-Duct Anastomosis: Long-Term Outcome and Its Related Factors after Endoscopic Treatment

Abstract

Endoscopic treatment is efficacious and has an acceptable long-term outcome in the management of biliary strictures related to RL-LDLT with duct-to-duct biliary anastomosis. Nonanastomotic stricture and stenosis of the hepatic artery are correlated with a worse outcome of endoscopic treatment.

Endoscopic management of biliary strictures after living donor liver transplantation

“…Overall biliary complications remain the most common complications after LDLT, with a reported incidence of 20-43%; biliary strictures and leakages are two major biliary complications that occur in 13-36 and 5-26% of cases, respectively (Table 1) [5][6][7][8][9][10][11]. While identification of the causative factors of biliary complications and subsequent refinements in reconstruction techniques might reduce the incidence of these complications in some institutions [20][21][22], the rate of biliary complications, particularly biliary strictures, does not seem to significantly decrease with experience [7,8,19,23].…”

“…Compared to DDLT using a whole liver, LDLT is technically more complex and challenging. Although refinements in surgical techniques, immunosuppressive management, and post-operative care have led to improved outcomes for LDLT [2][3][4], biliary complications, particularly biliary strictures, still develop in a substantial proportion of LDLT patients [5][6][7][8][9][10][11][12]. Biliary strictures affect long-term LDLT recipient outcomes and quality of life and can cause graft loss and even mortality [12,13].…”

Endoscopic Management of Biliary Complications After Liver Transplantation

“…This event was probably related to compensatory hypertrophy of the graft that resulted in sharp angulation of the bile duct rendering it extremely difficult to be managed endoscopically . Generally, it is recommended to start with endosocpic therapy as the first approach while percutaneous therapy should be spared for rescue therapy for following reasons (Chang et al, 2010). First, although the rates of successful interventions and patency do not differ for percutaneous or endoscopic therapy, the numbers of necessary interventions are higher for percutaneous therapy; second, the inconvenience of the percutaneous drain catheter cannot be ignored which significantly affects quality of life of those patients.…”

“…An 8 F pigtail catheter is inserted over the wire with its tip placed within the common bile duct or duodenum, and tubogram is then obtained. The catheter is anchored to the skin with anchoring device (Chang et al, 2010). If primary or rescue percutaneous approach is successfully performed, subsequent insertion of endoscopic retrograde biliary stents is recommended.…”

“…After stricture dilatation and minor sphincterotomy, stents as many and as big as possible, are endoscopically placed. The proximal side of the stent is located sufficiently over the stricture and the distal side of the stent is passed 1-2 cm outside the major papilla (Chang et al, 2010). Sphincterotomy is usually required during endoscopic stenting to avoid acute pancreatitis as a result of compression of pancreatic duct orifice by the duodenal end of stents.…”