Role of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of biliary tract complications after orthotopic liver transplantation

Baccarani, Umberto; Risaliti, Andrea; Zoratti, L.; Zilli, M.; Brosolo, P.; Vianello, Valentina; Pretis, G. De; Bresadola, F

doi:10.1016/s1590-8658(02)80092-5

Cited by 17 publications

(14 citation statements)

References 19 publications

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“…Whereas most studies focusing on anastomotic strictures describe the results of a specific therapy, our aim was describe the complete treatment, and to evaluate long‐term outcome for graft and patient survival. Many authors mention the prevalence of anastomotic strictures as a percentage of the total number of transplants, sometimes excluding patients dying within 30 days 10, 11, 17, 24, 25. In our series, the prevalence as calculated in that way is 8.9%, which compares well with previously published data.…”

Section: Discussionsupporting

confidence: 88%

“…Nonanastomotic stricture (NAS) is considered to result either from hepatic artery thrombosis or from more complex pathogenic processes, including immunological factors, prolonged cold ischemia times, and vascular insufficiency 1, 6–9. In most series, anastomotic biliary strictures are reported in 4–9% of patients 10–20. Treatment of these strictures can be endoscopic (endoscopic retrograde cholangiopancreaticography [ERCP]), percutaneous (percutaneous transhepatic cholangiodrainage [PTCD]), or surgical.…”

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confidence: 99%

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Anastomotic biliary strictures after liver transplantation: Causes and consequences

et al. 2006

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We retrospectively studied the prevalence, presentation, results of treatment, and graft and patient survival of grafts developing an anastomotic biliary stricture (AS) in 531 adult liver transplantations performed between 1979 and 2003. Clinical and laboratory information was obtained from the hospital files, and radiological studies were re-evaluated. Twenty-one possible risk factors for the development of AS (variables of donor, recipient, surgical procedure, and postoperative course) were analyzed in a univariate and stepwise multivariate model. Forty-seven grafts showed an anastomotic stricture: 42 in duct-toduct anastomoses, and 5 in hepaticojejunal Roux-en-Y anastomoses. The cumulative risk of AS after 1, 5, and 10 years was 6.6%, 10.6%, and 12.3% respectively. Postoperative bile leakage (P ϭ 0.001), a female donor/male recipient combination (P ϭ 0.010), and the era of transplantation (P ϭ 0.006) were independent risk factors for the development of an AS. In 47% of cases, additional (radiologically minor) nonanastomotic strictures were diagnosed. All patients were successfully treated by 1 or more treatment modalities. As primary treatment, endoscopic retrograde cholangiopancreaticography (ERCP) was successful in 24 of 36 (67%) cases and percutaneous transhepatic cholangiodrainage in 4 of 11 (36%). In the end 15 patients (32%) were operated, all with long-term success. AS presenting more than 6 months after transplantation needed more episodes of stenting by ERCP, and more stents per episode compared to those presenting within 6 months and recurred more often. Graft and patient survival were not impaired by AS. Liver Transpl 12:726-735, 2006.

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Section: Discussionsupporting

confidence: 88%

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confidence: 99%

Anastomotic biliary strictures after liver transplantation: Causes and consequences

et al. 2006

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“…ERC was successful in determining the cause and providing the therapy when indicated in 22 patients (71%). This compares to success rates of ERC at 87%, 84%, 71%, and 84% reported in some series in post‐OLT patients with choledochocholedochostomy9–12 (95% confidence interval [95% CI], 0.54, 0.87). However, this rate is significantly lower than the success rate reported in the medical literature for patients with normal anatomy13, 14 ( P < 0.0001; 95% CI, 0.54, 0.87).…”

Section: Resultsmentioning

confidence: 55%

“…JMP statistical software (SAS Institute Inc., Cary, NC) was used for the analysis. The success rate of ERC in treating the biliary complication was compared with the success rate in patients with OLT with choledochocholedochostomy9–12 and patients without surgically altered anatomy as reported in the medical literature 13, 14. Categorical and continuous variables were compared by the Fisher exact test.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic retrograde cholangiography in post–orthotopic liver transplant population with Roux-en-Y biliary reconstruction

et al. 2007

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Endoscopic retrograde cholangiography (ERC) is a well-established modality for diagnostic and therapeutic maneuvers in pancreaticobiliary disorders. However, it is technically more challenging in patients with postsurgical anatomy like Roux-en-Y anastomoses. Its effectiveness in post-orthotopic liver transplantation (OLT) patients with Roux-en-Y biliary reconstruction has not been reported. We sought to assess the efficacy and safety of ERC in this patient population. A total of 132 OLTs with Roux-en-Y biliary reconstruction were performed at our institution from June 1998 to August 2005. Data from consenting patients who underwent ERC were reviewed once they were identified through computerized medical index system. Of 132 OLT patients with Roux-en-Y biliary reconstruction, 31 patients (9 female and 22 male subjects ranging in age from 11 months to 70 years) underwent ERC. The indication for liver transplant was end-stage liver disease or occurrence of cholangiocarcinoma from primary sclerosing cholangitis in 28 patients and a case each of chronic hepatitis C, alcoholic liver disease, and metastatic islet cell carcinoma. A variable-stiffness pediatric colonoscope was used in most cases. ERC indications were both diagnostic and therapeutic and included the following: evaluation of increased liver biochemistries and fever in 12 patients, dilation of anastomotic biliary strictures in 10 patients, removal of fractured biliary tube or retained biliary stent in 6 patients, and in 1 patient each, biliary stone removal, management of bile leak, and jejunal tube extension placement for nutritional purpose. ERC was successful in 22 patients (71%). There were no postprocedural complications. Although ERC is technically more difficult and time-consuming in OLT patients with Roux-en-Y anastomoses, these data suggest that ERC is an effective and safe diagnostic and therapeutic modality with few or no complications when performed by experienced endoscopists. ERC was successful in most patients and allowed therapeutic interventions that obviated the need for percutaneous radiological intervention or surgery. Liver Transpl 13: [1168][1169][1170][1171][1172][1173] 2007. © 2007 AASLD.Received July 31, 2006; accepted March 16, 2007. Biliary complications after liver transplantation are an important cause of early and late postoperative morbidity and mortality. 1-5 The Roux-en-Y biliary reconstruction is considered the method of choice when liver transplantation is performed for intrinsic biliary disease and for patients with primary sclerosing cholangitis (PSC) because the reported rate of biliary complications is higher and the graft and patient survival worse in the latter patient population when choledochocholedochostomy is performed. 6 Percutaneous transhepatic cholangiography and surgical repair have been the primary management approaches for biliary complications after orthotopic liver transplantation (OLT) with Roux-en-Y reconstruction because the Roux-en-Y surgical bypass has routinely been considered to preclude endosc...

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“…AS tend to occur later than NAS. They are usually shorter and localized to the anastomotic site with an incidence of 4-9% [9,15,18]. NAS can be further classified into macroangiopathic, microangiopathic, and immunogenic causes (Table 3) [9,19].…”

Section: Biliary Stricturesmentioning

confidence: 99%

Biliary Complications Following Liver Transplantation

2010

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The aphorism that reconstruction of the biliary anastomosis is the "Achilles heel" of liver transplantation remains valid as biliary complications following liver transplantation remain a major source of morbidity with an incidence of 5-32%. Biliary complications include biliary strictures, biliary leaks, and stones. Biliary strictures can be divided into anastomotic and non-anastomotic. The management of biliary complications previously relied on surgical intervention. However, advances in endoscopic and radiological interventions have resulted in less-invasive options. The management of biliary complications post-liver transplantation requires a multidisciplinary approach and continues to evolve. Biliary complications also reflect the continued expansion of the donor pool with extended, live, and non-heart beating donors.

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Role of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of biliary tract complications after orthotopic liver transplantation

Cited by 17 publications

References 19 publications

Anastomotic biliary strictures after liver transplantation: Causes and consequences

Anastomotic biliary strictures after liver transplantation: Causes and consequences

Endoscopic retrograde cholangiography in post–orthotopic liver transplant population with Roux-en-Y biliary reconstruction

Biliary Complications Following Liver Transplantation

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