Prospective study of hepatobiliary scintigraphy and endoscopic cholangiography for the detection of early biliary complications after orthotopic liver transplantation

Kurzawinski, Tomasz R.; Selves, L.; Farouk, Marwan; Dooley, James; Hilson, A. J.W.; Buscombe, J. R.; Burroughs, Andrew K.; Rolles, K; Davldson, B. R.

doi:10.1002/bjs.1800840511

Cited by 46 publications

(33 citation statements)

References 13 publications

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“…14 However, biliary reconstruction without a T-tube requires careful post-OLT surveillance for bile leaks. 15 Three patients in this series had Roux-en-Y CDJ and 2 patients had gallbladder conduit as the primary method of bile duct reconstruction. The patients with gallbladder conduit underwent transplantation in 1988, and this technique has since been discontinued because of the incidence of bile stasis, stone formation, and cholangitis.…”

Section: Discussionmentioning

confidence: 99%

“…This is complicated by the occult nature of some biliary complications. Protocol cholangiography may be 1 method of achieving an earlier diagnosis, 15 although its efficacy has not been proven in a prospective randomized trial. The most common late complication after CDJ was biliary stricturing, affecting 8 of the 43 patients discharged from the hospital after CDJ (16%).…”

Section: Discussionmentioning

confidence: 99%

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Results of choledochojejunostomy in the treatment of biliary complications after liver transplantation in the era of nonsurgical therapies

et al. 2000

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Advances in radiological and endoscopic techniques have allowed many biliary complications after orthotopic liver transplantation (OLT) to be managed without surgery. The influence of nonsurgical management on the outcome of patients requiring surgical revision has not been addressed. We reviewed our 10-year experience (October 1988 to January 1998) of Roux-en-Y choledochojejunostomy (CDJ) to treat biliary complications after OLT. Forty-six patients underwent CDJ for biliary complications (32 men, 14 women; age, 22 to 65 years; median, 60 years). Biliary reconstruction at the time of OLT was duct to duct in 41 patients, primary CDJ in 3 patients, and gall bladder conduit in 2 patients. T-tubes were used only in patients with gallbladder conduit. The indication for CDJ was biliary leak (23 patients), stricture (20 patients), biliary stones (2 patients), and biliary sludge (1 patient). Two patients (4.3%) had associated hepatic artery thrombosis. The bile leaks were diagnosed at a median of 29 days post-OLT (range, 2 to 65 days) and strictures at a median of 2 years (range, 33 days to 6.5 years) post-OLT. Before surgery, 25 patients (54%) underwent an attempt at radiological or endoscopic therapeutic intervention that failed. Median follow-up was 5 years (range, 9 months to 10 years). Early complications occurred in 12 patients (26%); the most common was chest infection (4 patients). There were 3 perioperative deaths (6%); 1 death was directly related to surgery. Late complications, mainly anastomotic strictures, occurred in 10 patients (22%), half of which were successfully treated by biliary balloon dilatation. The complication rate post-CDJ was less in those who underwent a failed nonsurgical approach than those proceeding straight to surgery (9 of 25 patients; 36% v 13 of 21 patients; 62%; P =.21, not significant). The procedure-related mortality for surgical revision of biliary complications after OLT is low, but early and late complications are common. A failed attempt at nonsurgical management does not increase the complications of reconstructive surgery. Strictures after CDJ should be considered for biliary balloon dilatation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Results of choledochojejunostomy in the treatment of biliary complications after liver transplantation in the era of nonsurgical therapies

et al. 2000

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“…It can be used as the second step after ultrasound in patients for whom the use of diagnostic endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) carries a higher operational risk. Cholangiography is considered by all to be the gold standard not only in establishing the diagnosis but also in allowing therapeutic intervention in the same setting 51,52. ERCP has the advantage over PTC and is the first modality of choice as it is not only more physiological but also less invasive.…”

Section: Diagnosismentioning

confidence: 99%

Biliary Strictures after Liver Transplantation

Ryu

Lee²

2011

Gut Liver

129

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Biliary strictures are one of the most common complications following liver transplantation, representing an important cause of morbidity and mortality in transplant recipients. The reported incidence of biliary stricture is 5% to 15% following deceased donor liver transplantations and 28% to 32% following living donor liver transplantations. Bile duct strictures following liver transplantation are easily and conveniently classified as anastomotic strictures (AS) or non-anastomotic strictures (NAS). NAS are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and the need for retransplantation. Current endoscopic strategies to correct biliary strictures following liver transplantation include repeated balloon dilatations and the placement of multiple side-by-side plastic stents. Endoscopic balloon dilatation with stent placement is successful in the majority of AS patients. In patients for whom gaining biliary access is technically difficult, a combined endoscopic and percutaneous/surgical approach proves quite useful. Future directions, including novel endoscopic retrograde cholangiopancreatography techniques, advanced endoscopy, and improved stents could allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. The aim of this review is to detail the present status of endoscopy in the diagnosis, treatment, outcome, and future directions of biliary strictures related to orthotopic liver transplantation from the viewpoint of a clinical gastroenterologists.

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“…Regional sepsis and poor postoperative infection control can result in recurrent biliary leaks [24,25]. In the clinical scenario of a Roux-en-Y choledochojejunostomy without a transanastomotic catheter in place, a bile leak can be diagnosed with hepatobiliary scintigraphy and in selected patients with PTC [26,27].…”

Section: Specific Complicationsmentioning

confidence: 99%

Biliary complications after liver transplantation

Kalloo

2002

Curr Treat Options Gastro

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The incidence of biliary complications after liver transplant is estimated to be 8% to 20%. Post-liver transplant biliary complications may lead to acute and chronic liver injury. The early recognition and prompt treatment of such complications improves the long-term survival of the patient and graft. An understanding of the type of biliary reconstruction, the rationale for creating a particular anastomosis, and the technical difficulties in reconstructing the biliary tract are important in assessing and managing complications after liver transplant. Because the clinical presentation of these patients may be subtle, the physician must be aggressive and thoughtful in ordering and interpreting the diagnostic tests. Important points to remember are 1) that noninvasive examinations may fail to detect small obstructions or leaks, 2) a liver biopsy often is performed prior to cholangiography to exclude rejection and ischemia, and 3) the liver biopsy can miss an extrahepatic obstruction by misinterpreting portal inflammation as rejection. Biliary leaks and strictures are the most common biliary complications following liver transplant. Less common complications include ampullary dysfunction and stone/sludge formation. The effective management of biliary complications following a liver transplant depends on understanding the natural history, the prognosis, and the available therapeutic options for each type of complication.

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Prospective study of hepatobiliary scintigraphy and endoscopic cholangiography for the detection of early biliary complications after orthotopic liver transplantation

Abstract: This study suggests that scintigraphy is a useful screening test for biliary complications after OLT, ERC is only necessary if HBS is abnormal.

Cited by 46 publications

References 13 publications

Results of choledochojejunostomy in the treatment of biliary complications after liver transplantation in the era of nonsurgical therapies

Results of choledochojejunostomy in the treatment of biliary complications after liver transplantation in the era of nonsurgical therapies

Biliary Strictures after Liver Transplantation

Biliary complications after liver transplantation

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