Endoscopic Management of Biliary Leaks and Strictures After Living Donor Liver Transplantation: Optimizing Techniques for Successful Management

Elwir, Saleh; Thompson, Julie; Amateau, Stuart K.; Trikudanathan, Guru; Attam, Rajeev; Hassan, Mohamed A.; Kandaswamy, Raja; Pruett, Timothy L.; Lake, John R.; Chinnakotla, Srinath; Freeman, Martin L.; Arain, Mustafa A.

doi:10.1007/s10620-016-4367-z

Cited by 10 publications

(6 citation statements)

References 29 publications

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“… 16 Elwir et al reported that ERCP was the only treatment modality in 19 (90%) out of 21 patients who underwent ERCP due to leakage after LDLT. 22 Chok et al reported that half of the patients were successfully treated with endo-radiological method in a very small group of patients (n=12) after LDLT. 23 Although endoscopic treatments have taken priority over surgical treatments in the treatment of biliary stricture, there is still a need for surgical treatments when there is leakage.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of biliary complications in left lobe living donor liver transplantation

Erdoğan

Harputluoğlu

2018

TCRM

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PurposeAlmost all of the publications regarding the treatment of biliary complications after liver transplantation are related to biliary complications after right lobe living donor liver transplantation (LDLT) and cadaveric liver transplantation (LT). The number of publications regarding endoscopic treatment of biliary complications after left lobe LDLT is negligible. In this study, we aimed to present the results of endoscopic treatments applied in the management of biliary complications developed in left-lobe duct-to-duct LDLT patients.Patients and methodsBetween 2008 and 2018, patients with duct-to-duct anastomosis who underwent ERCP due to biliary complication after left lobe LDLT were included in the study. Clinical data included patient demographics, indications for LDLT, duration till the first ERCP after LDLT, number of ERCP procedures, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical interventions.ResultsAmong 13 patients who underwent ERCP, 2 (15%) had biliary leakage and 11 (8%) had an anastomotic stricture. Our endoscopic success rate was 100% in patients with biliary stricture. Despite the implementation of ERCP on two patients with leakage, they died due to the biliary complication.ConclusionOur results suggest that endoscopic treatment methods are successful in the management of biliary stricture complication in patients with left lobe LDLT and duct-to-duct anastomosis. Although our findings show that endoscopic treatments fail when there is a leakage after left lobe LDLT, there is a need for further studies that include more patients to reach a definite conclusion.

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Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of biliary complications in left lobe living donor liver transplantation

Erdoğan

Harputluoğlu

2018

TCRM

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“…Differentiating benign from malignant biliary strictures (BBS and MBS respectively) remains a challenge despite advances in imaging and tissue cytogenetic profiling techniques (20)(21)(22). BBS are most commonly iatrogenic in aetiology, and are frequently observed following liver and pancreato-biliary surgery, including cholecystectomy (23)(24)(25). The formation of biliary anastomosis is often complicated by strictures which can be a single, localised (anastomotic strictures) or multiple and rather more proximal to the anastomosis site in their non-anastomotic counterparts (23).…”

Section: Diagnosis and Management Of Benign And Malignant Biliary Stricturesmentioning

confidence: 99%

Biliary Strictures and Cholangiocarcinoma – Untangling a Diagnostic Conundrum

et al. 2021

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Cholangiocarcinoma is an uncommon and highly aggressive biliary tract malignancy with few manifestations until late disease stages. Diagnosis is currently achieved through a combination of clinical, biochemical, radiological and histological techniques. A number of reported cancer biomarkers have the potential to be incorporated into diagnostic pathways, but all lack sufficient sensitivity and specificity limiting their possible use in screening and early diagnosis. The limitations of standard serum markers such as CA19-9, CA125 and CEA have driven researchers to identify multiple novel biomarkers, yet their clinical translation has been slow with a general requirement for further validation in larger patient cohorts. We review recent advances in the diagnostic pathway for suspected CCA as well as emerging diagnostic biomarkers for early detection, with a particular focus on non-invasive approaches.

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“…BBSs are more frequent after LDLT than after OLT. [52][53][54][55][56] Overall, the incidence of BBSs is 25%-32% after LDLT [57][58][59][60][61] and 5%-15% after OLT. 39,60,62 The higher incidence of post-LDLT strictures is due to technical aspects of the operation because ductal anastomosis between the donor and the recipient during LDLT is complicated.…”

Section: Post-orthotopic Liver Transplantation Stricturesmentioning

confidence: 99%

Magnetic Compression Anastomosis for the Treatment of Post-Transplant Biliary Stricture

2020

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A number of different conditions can lead to a bile duct stricture. These strictures are particularly common after biliary operations, including living-donor liver transplantation. Endoscopic and percutaneous methods have high success rates in treating benign biliary strictures. However, these conventional methods are difficult to manage when a guidewire cannot be passed through areas of severe stenosis or complete obstruction. Magnetic compression anastomosis has emerged as an alternative nonsurgical treatment method to avoid the mortality and morbidity risks of reoperation. The feasibility and safety of magnetic compression anastomosis have been reported in several experimental and clinical studies in patients with biliobiliary and bilioenteric strictures. Magnetic compression anastomosis is a minimally traumatic and highly effective procedure, and represents a new paradigm for benign biliary strictures that are difficult to treat with conventional methods.

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Endoscopic Management of Biliary Leaks and Strictures After Living Donor Liver Transplantation: Optimizing Techniques for Successful Management

Cited by 10 publications

References 29 publications

Endoscopic treatment of biliary complications in left lobe living donor liver transplantation

Endoscopic treatment of biliary complications in left lobe living donor liver transplantation

Biliary Strictures and Cholangiocarcinoma – Untangling a Diagnostic Conundrum

Magnetic Compression Anastomosis for the Treatment of Post-Transplant Biliary Stricture

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