Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review

Abstract

Background/Aims Bile leak is one of the most common complications of liver transplantation. The treatment options for bile leaks include conservative management, surgical re-intervention, percutaneous drainage and endoscopic drainage. We aimed to perform a systematic review to identify the efficacy of endoscopic treatment in the resolution of post-transplant bile leaks. Methods Two independent reviewers performed systematic literature search in PubMed, ISI Web of Science, grey literature and relevant references in May 2017. Human studies in English with documented post-liver transplant bile leaks were included. Results Thirty-four studies were included in the final analysis. The pooled efficacy of biliary stents for the resolution of post-transplant bile leaks was 82.43% compared with 87.15% efficacy of nasobiliary tubes. The efficacy of biliary stents was lower for anastomotic leaks (69.23%) compared to T-tube (90.9%) or cut-surface/ cystic duct stump related leaks (92.8%). Similarly, the efficacy of nasobiliary tube was also lower for anastomotic leaks (58.33%) compared to T-tube or cut-surface related leaks (100%). Conclusions In this systematic review, the overall efficacy was 82.43% in biliary stent group, and 87.15% in nasobiliary tube group. Both biliary stent and nasobiliary tube were more effective in managing non-anastomotic leaks compared to anastomotic leaks.

Complications in Post-Liver Transplant Patients

“…Biliary complications are quite common after LT, with a global incidence ranging from 2% to 19% [126]. These complications are related to significant postoperative morbidity and mortality rates after LT [127,128].…”

Biliary Complications Following Adult Deceased Donor Liver Transplantation: Risk Factors and Implications at a High-volume US Center

“…21 Treatment of bile leaks with an ERCP and plastic stent placement resolves early bile leaks in 82%-95% of cases. 22,23 Similarly, ERCP with serial balloon dilation and exchange of biliary stents every 3 mo for 1-2 y is the first-line therapy for most anastomotic biliary strictures. One systematic review of 440 liver transplant patients with anastomotic biliary strictures found that those treated for >12 mo with serial dilation and stent exchange resolved their strictures 97% of the time, 24 and another large series of 69 patients found that 94% of these biliary strictures could be successfully resolved with endoscopic management.…”

Current Research Status of Primary Closure after Laparoscopic Biliary Exploration

“…Laparoscopic choledochal exploration with primary suture combined with C tube drainage. Some studies have shown that intraoperative or preoperative placement of ENBD combined with primary closure suture can drain bile, reduce bile duct pressure, decrease the occurrence of bile leakage, and support the bile duct to reduce biliary stricture [13,14]. Some studies have shown that laparoscopic choledochal exploration with primary closure suture combined with PTCD tube is effective in reducing operative time and postoperative hospitalization compared with T-tube drainage [15] However, Primary suture combined with PTCD can also reduce bile drainage and biliary pressure, which can reduce the incidence of postoperative bile leakage and biliary stricture to a certain extent, but there are more steps to be performed, longer time to carry the tube, and the placement of PTCD has the corresponding complications.…”