Cholangioscopy-assisted guidewire placement in post-liver transplant anastomotic biliary stricture: efficient and potentially also cost-effective

Martins, Fernanda P.; Ferrari, Ângelo Paulo

doi:10.1055/s-0043-117940

Cited by 19 publications

(19 citation statements)

References 4 publications

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“…However, ABSs can sometimes be tight, fibrotic, and angulated, not allowing guidewire to pass despite the use of multiple accessories. In this case, there is some experience with the use of cholangioscopy to identify the stricture orifice and advance the guidewire under direct guidance, with reported success in 100% of patients in a small study on 5 patients . The endoscopic approach has been previously successfully used for the more frequent postcholecystectomy biliary strictures .…”

Section: Endoscopic Management Of Biliary Stricturesmentioning

confidence: 99%

“…In this case, there is some experience with the use of cholangioscopy to identify the stricture orifice and advance the guidewire under direct guidance, with reported success in 100% of patients in a small study on 5 patients. (32) The endoscopic approach has been previously successfully used for the more frequent postcholecystectomy biliary strictures. (33) Initially, BD was used alone, but because of the high rate of recurrent stricture formation, (34) stenting was added, resulting in a more adequate rate of treatment response.…”

Section: Anastomotic Biliary Stricturesmentioning

confidence: 99%

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Endoscopic Management of Benign Biliary Strictures After Liver Transplantation

et al. 2019

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Biliary strictures represent some of the most frequent complications encountered after orthotopic liver transplantation. They comprise an array of biliary abnormalities with variations in anatomical location, clinical presentation, and different pathogenesis. Magnetic resonance cholangiography represents the most accurate noninvasive imaging test that can provide detailed imaging of the whole biliary system—below and above the anastomosis. It is of particular value in those harboring complex hilar or intrahepatic strictures, offering a detailed roadmap for planning therapeutic procedures. Endoscopic therapy of biliary strictures usually requires biliary sphincterotomy plus balloon dilation and stent placement. However, endoscopic management of nonanastomotic biliary strictures is much more complex and challenging as compared with anastomotic biliary strictures. The present article is a narrative review presenting the results of endoscopic treatment of biliary strictures occurring after liver transplantation, describing the different strategies based on the nature of the stricture and summarizing their outcomes.

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Section: Endoscopic Management Of Biliary Stricturesmentioning

confidence: 99%

Section: Anastomotic Biliary Stricturesmentioning

confidence: 99%

Endoscopic Management of Benign Biliary Strictures After Liver Transplantation

et al. 2019

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“…Direct cholangioscopy (spyglass) is currently available in some centers as an interesting option that allows the direct visualization of the stricture facilitatating its transposition in severe cases. Even though the device presents a high cost, an analysis performed in a Brazilian institution showed that this technique presented a cost lower than EUSBD and PTBD (169) . However, data on the use of EUSBD and direct cholangioscopy in cases of benign biliary stric tures still very limited and these procedures should be considered only in selected centers with high expertise and when PTBD is not available or cannot be performed.…”

Section: Benign Biliary Stricturementioning

confidence: 99%

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

Schiavon

Ejima

Menezes

et al. 2019

Arq. Gastroenterol.

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Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepatology (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.

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“…The opportunity for visual assessment of the bile ducts facilitates to detect epithelial changes, ulcers, small stones, bile casts not detectable by ERCP or crossectional imaging, to distinguish anastomotic from non-anastomotic strictures. It is also possible to selectively cannulate complex, angulated or excentric strictures who failed conventional fluoroscopy-guided negotiation[21-23].…”

Section: Posttransplant Biliary Complicationsmentioning

confidence: 99%

“…According to another case series, successful placement of a guidewire across the post-LT stricture under visual control was achieved in 5 cases. All of these strictures had failed cannulation under fluoroscopic guidance[21]. Overall, the published data concluded that D-SOC is safe and in many cases superior to ERCP in managing post-LT biliary complications.…”

Section: Posttransplant Biliary Complicationsmentioning

confidence: 99%

Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders

Karagyozov¹,

Boeva²,

Tishkov³

2019

WJGE

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Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy (SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future expectations. Digital SOC (D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors (extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree, unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography (ERCP) alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.

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Cholangioscopy-assisted guidewire placement in post-liver transplant anastomotic biliary stricture: efficient and potentially also cost-effective

Cited by 19 publications

References 4 publications

Endoscopic Management of Benign Biliary Strictures After Liver Transplantation

Endoscopic Management of Benign Biliary Strictures After Liver Transplantation

Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders

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