Rendezvous technique combining double-balloon endoscopy with percutaneous cholangioscopy is useful for the treatment of biliary anastomotic obstruction after liver transplantation (with video)

Tsukui, Daisuke; Yano, Tomonori; Nakazawa, Kenji; Osawa, Hiroyuki; Kawano, Yoichi; Mizuta, Koichi; Kawarasaki, Hideo; Yamamoto, Hironori

doi:10.1016/j.gie.2008.02.034

Cited by 14 publications

(6 citation statements)

References 8 publications

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“…Advanced endoscopic techniques using direct cholangioscopy enable direct visualization and directed therapy within the bile duct. [51][52][53][54][55][56] Direct visualization may help to differentiate biliary casts from strictures and aid in the directed acquisition of tissue for sampling purposes. Cholangioscopy can also be used for the removal of stones and sludge and for the documentation of complete ductal clearance.…”

Section: Treatment Of Biliary Tract Complicationsmentioning

confidence: 99%

Advances in endoscopic management of biliary tract complications after liver transplantation

2013

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Biliary tract complications after liver transplantation (LT) most commonly include biliary leaks, strictures, and stone disease. Living donor recipients and donation after cardiac death recipients are at an increased risk of developing biliary complications. Biliary leaks usually occur early after transplantation, whereas strictures and stone disease occur later. The diagnosis of biliary complications relies on a combination of clinical presentation, laboratory abnormalities, and imaging modalities. Biliary leaks are usually diagnosed on the basis of bilious output from a surgical drain, fluid collections on imaging, or a cholescintigraphy scan demonstrating a leak. Magnetic resonance cholangiopancreatography (MRCP) is noninvasive, does not require the administration of an intravenous contrast agent, and provides detailed imaging of the entire biliary system both above and below the anastomosis. The latter not only helps in the diagnosis of biliary strictures and stones before patients undergo invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) but also allows treating physicians to plan the optimal treatment approach. MRCP has, therefore, replaced invasive therapeutic modalities such as ERCP as the modality of choice for the diagnosis of biliary strictures and stones. There have been significant advances in endoscopic accessories, including biliary catheters, wires, and stents, as well as endoscopic technologies such as overtube-assisted endoscopy over the last decade. These developments have resulted in almost all patients, including those with difficult strictures or altered surgical anatomies (eg, Roux-en-Y hepaticojejunostomy), being treated via an endoscopic approach with percutaneous transhepatic cholangiography, which is more invasive and associated with significant morbidity, with surgery being reserved for a small minority of patients. Advances in the diagnosis and endoscopic management of patients with biliary complications after LT are discussed in this review.

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Section: Treatment Of Biliary Tract Complicationsmentioning

confidence: 99%

Advances in endoscopic management of biliary tract complications after liver transplantation

2013

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“…In 61/63 patients, the double balloon technique was used, whereas in 2 patients a single balloon technique was employed [18] . Two recent reports illustrate the usefulness of a rendezvous approach in which percutaneous transhepatic cholangioscopy was combined with DBE [12,16] . Importantly, in none of the reports were serious complications encountered.…”

Section: Resultsmentioning

confidence: 99%

ERCP with the Balloon-Assisted Enteroscopy Technique: A Systematic Review

Koornstra

Fry

Mönkemüller

2008

Dig Dis

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is generally difficult with conventional instruments in patients with surgically altered gastrointestinal anatomy. Balloon-assisted enteroscopy is a relatively new technique that allows for access to the papilla of Vater or a biliodigestive anastomosis in postsurgical reconstructions. Aim: To systematically review the utility of balloon-enteroscope-assisted ERCP for patients with altered gastrointestinal anatomy. Material and Methods: Systematic search of the literature on diagnostic and therapeutic interventions in the pancreaticobiliary system using balloon-assisted enteroscopy in patients with previous intestinal surgery indexed in of MEDLINE, Current Contents, PubMed, and references from relevant articles using the search terms ‘balloon’, ‘enteroscopy’, ‘endoscopy’, ‘ERCP’ and ‘cholangiography’. Only papers published as ‘full text’ in English were included. Results: In total, 16 relevant reports are available on balloon-assisted procedures performed in 63 patients with a variety of anatomical configurations. Double balloon procedures as well as single balloon techniques have been reported. Successful interventions in these patients include balloon dilation of stenotic biliodigestive anastomoses, sphincterotomy, extraction of bile stones and stent placement. No serious complications have yet been reported. Conclusions: Balloon-assisted enteroscopy is a safe and feasible technique to obtain biliary or pancreatic access in patients with surgically altered anatomical configurations. The diagnostic and therapeutic potential of balloon-assisted ERCP is large, and could be further improved if customized accessories become more widely available.

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“…In recipients with biliary obstruction, endoscopic intervention using DBE performed after PTBD is carried out. Thereafter, the penetration and balloon dilatation of the biliary obstruction site are performed using combined percutaneous cholangiography and endoscopic jejunography (the “rendezvous method”) . Although we believe that the rendezvous method for post‐transplant biliary obstruction is effective, the success rate of the rendezvous method was 50.0% (6/12).…”

Section: Discussionmentioning

confidence: 99%

“…When the patients are diagnosed with biliary strictures by PTBD or DBE, balloon dilatation is performed. When obstruction of the hepaticojejunal anastomotic site or intrahepatic bile duct is diagnosed, balloon dilatation using the rendezvous method with combined cholangioscopy or cholangiography via PTBD and DBE or jejunography via DBE is performed . If the nonsurgical interventions by the balloon dilatation or rendezvous method are unsuccessful, surgical re‐anastomosis is performed.…”

Section: Methodsmentioning

confidence: 99%

Long‐term outcome of percutaneous transhepatic biliary drainage for biliary strictures following pediatric liver transplantation

Sanada

Katano

Hirata

et al. 2019

Clinical Transplantation

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Background We present a retrospective analysis of our experience with pediatric liver transplantation (LT), focusing on the long‐term outcome of percutaneous transhepatic biliary drainage (PTBD) for post‐transplant biliary strictures. Methods Fifty‐three PTBDs were performed for 41 pediatric recipients with biliary strictures. The median ages at LT and PTBD were 1.4 and 4.4 years, respectively. The median observation period was 10.6 years. Results Post‐transplant biliary strictures comprised anastomotic stricture (AS) in 28 cases, nonanastomotic stricture (NAS) in 12, anastomotic obstruction (AO) in 8, and nonanastomotic obstruction (NAO) in 5. The success rate of PTBD was 90.6%, and the 15‐year primary patency rate of PTBD was 52.6%. The recurrence rate of biliary strictures after PTBD was 18.8% (9/48), and among the four NAS cases with recurrence, two underwent re‐LT. The biliary obstruction rate was 27.1% (13/48). Among the eight cases with AO, five underwent the rendezvous method and three underwent surgical re‐anastomosis. Among the five cases with NAO, one underwent re‐LT. The recipient survival rate of PTBD treatment was 100%. Conclusions The graft prognosis of AS by PTBD treatment is good and AO is curable by the rendezvous method and surgical re‐anastomosis. However, the graft prognosis of NAS and NAO is poor.

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Rendezvous technique combining double-balloon endoscopy with percutaneous cholangioscopy is useful for the treatment of biliary anastomotic obstruction after liver transplantation (with video)

Cited by 14 publications

References 8 publications

Advances in endoscopic management of biliary tract complications after liver transplantation

Advances in endoscopic management of biliary tract complications after liver transplantation

ERCP with the Balloon-Assisted Enteroscopy Technique: A Systematic Review

Long‐term outcome of percutaneous transhepatic biliary drainage for biliary strictures following pediatric liver transplantation

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