Interventional treatment of a biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis

Na, Gun Hyung; Kim, Dong Goo; Choi, Ho Joong; Han, Jae Hyun; Hong, Tae Ho; You, Young Kyoung

doi:10.1111/hpb.12151

Cited by 26 publications

(40 citation statements)

References 23 publications

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“…Endoscopic management of biliary anastomotic strictures following RL LDLT is technically difficult most of the time, and recent studies have reported a technical success rate of 46.7%‐81.5% . In the present study, the technical and clinical success rates were generally in agreement with those of the previous studies.…”

Section: Discussionsupporting

confidence: 91%

Optimal Biliary Drainage for Patients With Biliary Anastomotic Strictures After Right Lobe Living Donor Liver Transplantation

et al. 2019

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Right lobe (RL) living donor liver transplantation (LDLT) usually includes 2 bile duct anastomosis sites, namely, the right anterior and the right posterior segmental ducts. This study aimed to evaluate the optimal treatment for biliary strictures following RL LDLT with respect to unilateral or bilateral drainage techniques. From January 2005 to December 2017, 883 patients at Seoul National University Hospital underwent RL LDLT. Of these, 110 patients were enrolled who had 2 duct‐to‐duct anastomosis sites and who were considered at risk of developing biliary anastomotic strictures. Unilateral or bilateral biliary drainage during the follow‐up period was identified by endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous transhepatic biliary drainage (PTBD). The clinical success, complication, and 180‐day mortality rates were compared between the unilateral and bilateral biliary drainage groups according to the initial ERCP findings. The mean age at the time of LDLT was 54.2 ± 8.2 years. The median time from LDLT to initial biliary anastomotic strictures was 177 (interquartile range, 18‐1085) days. At the initial ERCP, unilateral drainage was performed in 55 (50.0%) patients, and bilateral drainage was performed in 11 (10.0%) patients. Of the patients who underwent unilateral drainage, 35 (63.6%) patients required conversion to bilateral drainage during follow‐up. Overall, 71 (64.5%) patients required bilateral drainage more than once, whereas only 27 (24.5%) patients reached a resolution with unilateral biliary drainage. In this study, most patients required bilateral biliary drainage more than once during follow‐up. An active attempt should be made to drain bilaterally in patients with biliary anastomotic strictures following RL LDLT.

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Section: Discussionsupporting

confidence: 91%

Optimal Biliary Drainage for Patients With Biliary Anastomotic Strictures After Right Lobe Living Donor Liver Transplantation

et al. 2019

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“…Other risk factors for BAS identified in multivariate analyses include donor age [50 years [8], preoperative MELD score C35 [27], urgency of the surgery [33], bile duct diameter [34], a graft with multiple bile ducts [31], graft cold ischemia time [24,34], hepatic artery stenosis [31], and acute cellular rejection [24]. Whether the biliary reconstruction technique affects the development of BAS is controversial.…”

Section: Etiologies and Risk Factors For Biliary Strictures After Ldltmentioning

confidence: 99%

“…The results of balloon dilation followed by PS placement for BAS have been variable, with technical endoscopic and final endoscopic success rates ranging from 40-84% and from 20-100%, respectively [26,28,31,33,54,[62][63][64]. Technical endoscopic success is defined as successful placement of biliary stents without the aid of a percutaneous procedure (i.e., rendezvous technique), and final endoscopic success is resolution of BAS after stent removal.…”

Section: Plastic Stent Placementmentioning

confidence: 99%

“…c Endoscopic view of the papilla; the platinum, radiopaque-marked retrieval string and the nylon threads are visible tight stricture, rendering endoscopic management difficult. In addition, experience in endoscopic management in LDLT patients has an impact on stricture resolution by ERCP [11,33,64].…”

Section: Risk Factors or Failed Endoscopic Management Of Post-ldlt Bimentioning

confidence: 99%

“…At the University of Tokyo, we observed recurrent stricture in 1 (4%) of 25 patients with stricture resolution with inside stents over a median period after stent removal of 52 months [unpublished data]. If strictures are treated adequately, the development of BAS does not affect overall survival after LDLT [9,24,31,33]. Chok et al reported that there were no significant differences in 1-, 3-, and 5-year graft survival rates between patients with and without BAS [24].…”

Section: Long-term Outcomes Of Endoscopic Management Of Post-ldlt Bilmentioning

confidence: 99%

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Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation: a 9-year single-center experience

Lee¹,

Lee

Kim³

et al. 2022

Eur Radiol

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Interventional treatment of a biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis

Abstract: The incidence of overall biliary stricture was related to bile leakage and the urgency of the surgery. All biliary strictures could be treated by interventional modalities. These approaches are effective, complementary and help to avoid the need for surgery for a biliary stricture.

Cited by 26 publications

References 23 publications

Optimal Biliary Drainage for Patients With Biliary Anastomotic Strictures After Right Lobe Living Donor Liver Transplantation

Optimal Biliary Drainage for Patients With Biliary Anastomotic Strictures After Right Lobe Living Donor Liver Transplantation

Endoscopic management of biliary strictures after living donor liver transplantation

Percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation: a 9-year single-center experience

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