Refractory anastomotic bile leaks after orthotopic liver transplantation are associated with hepatic artery disease

DaVee, Tomas; Geevarghese, Sunil K.; Slaughter, James C.; Yachimski, Patrick

doi:10.1016/j.gie.2016.08.050

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…Four studies reported data on covered self-expandable metal stents (CSEMS) [19,28-30]. Three studies [19,28,29] described outcomes in fully covered self-expandable metal stents (FCSEMS) while one study [30] reported outcomes for both FCSEMS and partially covered self-expandable metal stents (PCSEMS). Two studies exclusively included patients who failed previously placed plastic stents [28,29], and the other two studies reported patients with endoscopic treatment failure (previous plastic stents) as well as treatment naïve patients [19,30].…”

Section: Resultsmentioning

confidence: 99%

“…Both BS and NBT were highly efficacious for T-tube and cystic duct stump leaks, but the efficacy appears lower for anastomotic leaks (Table 5). DaVee et al [29] looked at the refractory BLs and noted that hepatic artery disease and portal vein thrombosis were significant contributing factors for the refractory leaks. Hepatic vascular compromise leads to stricturing of the bile duct, which in turns leads to the anastomotic leak.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Factors contributing to post-LT biliary leakage include ischemic injury to hepatic artery, cystic duct leakage, partial or full anastomotic site disruption, and cut surface leakage in LDLT. 25,37,38 Leaks may be extrahepatic or intrahepatic with extravasation into the hepatic parenchyma. The onset of biliary leak can occur immediately after transplant to 6 months after transplant.…”

Section: Bile Leaksmentioning

confidence: 99%

“…7 Refractory leaks that persist despite plastic biliary stent placement are associated with hepatic artery ischemia. 38 Diagnosis of bile leaks requires a high degree of suspicion. Symptoms of a bile leak include abdominal pain, fever, sepsis, and persistent bilious output from intraabdominal drains with bilirubin level from the drain exceeding the serum concentration.…”

Section: Bile Leaksmentioning

confidence: 99%

Endoscopic Management of Biliary Complications after Liver Transplant

2019

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Orthotropic liver transplant (OLT) is the definitive treatment for patients with end stage liver disease of all etiologies. Biliary complications are common after OLT and living donor liver transplant (LDLT). Approximately, 15% of patients undergoing deceased donor liver transplant develop strictures and this number is even higher in LDLT recipients (28–32%).1 2 Common biliary complications include anastomotic and non-anastomotic strictures, bile leaks, biliary casts, and stones.3 Endoscopic therapy has become the mainstay of management of these biliary conditions. Endoscopic therapy involves sphincterotomy, dilation, and stent deployment to maintain patency of the bile duct and provide adequate drainage. This article will review current literature regarding endoscopic management of biliary complications after liver transplant and discuss recent endoscopic advances that can reduce the need for reoperation.

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“…Thus, anastomotic (mostly CC) biliary strictures were found in 60% of OLT patients with hepatic artery stenosis versus 10% in matched control patients without hepatic artery stenosis in another recent study, 9 although the impact of these findings on treatment outcomes was not analyzed. Because treatment response is easier to assess for leaks than for strictures, by using their institutional protocol, DaVee et al 8 were able to find a strong association between failure of standard endoscopic treatment with plastic stents within a predefined time frame and hepatic artery disease in patients with post-OLT anastomotic leaks. Most refractory leaks were found at follow-up ERCP, in as much as only 2 patients required surgical biliary revision for "uncontrolled" leaks and another patient required repeat LT for liver failure in the setting of HAT.…”

mentioning

confidence: 99%

Hepatic artery disease and anastomotic bile leaks after liver transplantation: shining the light on the true Achilles’ heel

Peñas-Herrero

Pérez-Miranda

2017

Gastrointestinal Endoscopy

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Refractory anastomotic bile leaks after orthotopic liver transplantation are associated with hepatic artery disease

Cited by 10 publications

References 25 publications

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

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

Endoscopic Management of Biliary Complications after Liver Transplant

Hepatic artery disease and anastomotic bile leaks after liver transplantation: shining the light on the true Achilles’ heel

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