Efficacy of Endoscopic Retrograde Cholangiopancreatography in the Treatment of Biliary Complications following Liver Transplant: 10 Years of a Single-Centre Experience

Alves, Ana Rita; Gomes, Dário; Furtado, Emanuel; Tomé, Luís

doi:10.1159/000480704

Cited by 9 publications

(10 citation statements)

References 16 publications

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“…[6][7][8]24,25,[27][28][29][30][31] This can be explained by the fact that there is no consensus on the definition of post-transplantation AS, as many studies do not specify a definition of AS or do so very imprecisely. 13,27,[32][33][34][35][36] The median time to the occurrence of stenosis is 3 months, but 69.6% of AS occur within 6 months of the transplantation. The majority of studies on the subject seem to corroborate this time to occurrence in the first 6-12 months.…”

Section: Discussionmentioning

confidence: 99%

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Management of anastomotic biliary stricture after liver transplantation and impact on survival

Jarlot-Gas

Muscari

Mokrane

et al. 2021

HPB

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Section: Discussionmentioning

confidence: 99%

“…The majority of studies on the subject seem to corroborate this time to occurrence in the first 6-12 months. 25,27,31,32,37 One recent study 33 found a longer time frame however, 19 months, between the OLT and the first ERCP.…”

Section: Discussionmentioning

confidence: 99%

Management of anastomotic biliary stricture after liver transplantation and impact on survival

Jarlot-Gas

Muscari

Mokrane

et al. 2021

HPB

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“… 17 , 18 The average number of times the procedure needs repeating is four and a successful outcome is achieved in 46%–90% of cases. 19 , 20 In situations where endoscopic access via the ampulla no longer exists, such as duct-to-bowel anastomoses, dilation and stenting can be performed percutaneously. Five patients in our study required biliary reconstruction due to unsuccessful endoscopic or percutaneous intervention.…”

Section: Discussionmentioning

confidence: 99%

Biliary Strictures Are Associated With Both Early and Late Hepatic Artery Stenosis

Hann

Seth

Mergental

et al. 2020

Transplantation Direct

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Background. Hepatic artery stenosis (HAS) following liver transplantation results in hypoperfusion and ischemic damage to the biliary tree. This study aimed to investigate how vascular intervention, liver function test derangement, and time point of HAS onset influence biliary complications. Methods. A single-center retrospective study of adult patients that underwent primary liver transplantation. Patients were grouped according to the presence or absence of HAS and then into early (≤90 d) or late (>90 d) subgroups. Biliary complications comprised anastomotic (AS) or non ASs (NASs). Results. Computed tomography angiography confirmed HAS was present in 39 of 1232 patients (3.2%). This occurred at ≤90 and >90 days in 20 (1.6%) and 19 (1.5%), respectively. The incidence of biliary strictures (BSs) in the group with HAS was higher than the group without (13/39; 33% versus 85/1193; 7.1%, P = 0.01). BS occurred in 8/20 (40.0%) and 5/19 (26.3%) of the early and late groups, respectively. The need for biliary intervention increased if any liver function test result was ≥3× upper limit of normal (P = 0.019). Conclusions. BS occurs at a significantly higher rate in the presence of HAS. Onset of HAS at ≤90 or ≥90 days can both be associated with morbidity. Significant liver function test derangement at HAS diagnosis indicates a higher likelihood of biliary intervention for strictures.

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“…Biliary complications occur in 10%‐40% of patients in the post‐LT setting, causing significant morbidity and in some cases threatening graft and patient survival 2‐5 . These complications include NAS, AS, sphincter of Oddi dysfunction, anastomotic leaks, stones, sludge, and casts (the most common of which are leaks, strictures, and stones) 2‐8 . Stones independently are a relatively rare complication, occurring in 2%‐6% of LT recipients 9 .…”

Section: Discussionmentioning

confidence: 99%

“…One method of treatment for biliary complications post‐LT is called the rendezvous technique, in which radiologic percutaneous and endoscopic approaches are combined 15 . In a retrospective study of 120 patients with biliary complications following LT, ERCP successfully treated 46% of cases (either isolated or rendezvous), and percutaneous transhepatic cholangiography and/or surgery were successful in 48% of patients in whom ERCP had proven unsuccessful 3 . One report describes a case of successful biliary stone removal in the setting of AS using the rendezvous technique and an electro‐kinetic lithotriptor 15 .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous removal of biliary stones post‐liver transplant in a pediatric patient: Case report and review of the literature

Rohringer

Hannick

Lorenzo

et al. 2020

Pediatric Transplantation

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This is a case of a girl born with citrullinemia diagnosed in her firstweek of life after presenting with hyperammonemia and encephalopathy. At 1 year of age, she received a deceased donor segmental split left LT due to recurrent and refractory metabolic decompensations despite optimal medical and dietary management. During the initial LT, a duct-to-duct anastomosis was performed. One week later, the patient required a revision of the biliary anastomosis due to a bile leak and subphrenic abscess. During revision, the end-toend anastomosis was taken down, and a bilio-enteric anastomosis was created using a Roux-en-Y hepatojejunostomy. A surgical drain remained in place for 1 month, after which a cholangiogram revealed stenosis of the anastomosis with a biliary stricture. The biliary drain AbstractThis case report describes an 8-year-old girl who underwent a segmental LT for a primary diagnosis of citrullinemia at the age of 12 months. She presented with cholangitis secondary to stenosis of the biliary-enteric anastomosis. MRI revealed dilatation of intrahepatic bile ducts associated with multiple stones. An endoscopic approach failed to decompress the bile ducts and remove the stones. A percutaneous approach was then undertaken. After placement of a temporary external biliary drain for 12 days, a 26 French sheath was placed to access the bile ducts. Using a 14Fr flexible cystoscope, 80%-90% of the biliary stones were removed. This was followed by antegrade balloon dilatation of the biliary-enteric anastomosis. Two months later, the procedure was repeated, resulting in complete clearance of the biliary stones. An internal-external biliary drain was maintained in placed for 10 months. The patient has been asymptomatic, with no evidence of stone recurrence for 13 months after drain removal. Percutaneous biliary stone removal is commonly performed in adults with non-transplanted livers, especially in complex cases, and has also been shown to be successful in the pediatric population. However, it is rarely reported in transplanted livers in adults, and to the best of our knowledge, no pediatric cases have been reported. This case illustrates that this technique can be successfully utilized in pediatric LT patients. K E Y W O R D S biliary complications, biliary stones, citrullinemia, liver transplantation, pediatric liver transplant, percutaneous stone removal How to cite this article: Rohringer TJ, Hannick JH, Lorenzo A, Avitzur Y, Temple M, Parra DA. Percutaneous removal of biliary stones post-liver transplant in a pediatric patient: Case report and review of the literature. Pediatr Transplant.

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Efficacy of Endoscopic Retrograde Cholangiopancreatography in the Treatment of Biliary Complications following Liver Transplant: 10 Years of a Single-Centre Experience

Cited by 9 publications

References 16 publications

Management of anastomotic biliary stricture after liver transplantation and impact on survival

Management of anastomotic biliary stricture after liver transplantation and impact on survival

Biliary Strictures Are Associated With Both Early and Late Hepatic Artery Stenosis

Percutaneous removal of biliary stones post‐liver transplant in a pediatric patient: Case report and review of the literature

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