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

Abstract

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.

Endoscopic Management of Biliary Complications after Liver Transplant

“…The standard therapeutic approach to bile leaks is through equalization of pressure in the bile duct and duodenum, allowing antegrade flow of bile into the duodenum. 22,28,29,[60][61][62][63][64][65][66][67][68] to 50% of cases within 24 hours 39 with the option of continuing for prolonged periods of time in remaining cases. ERCP is the first line for management of bile leaks.…”