Role of Interventional Radiology in the Treatment of Biliary Strictures Following Orthotopic Liver Transplantation

Righi, Dorico; Cesarani, Federico; Muraro, Emanuele; Gazzera, Carlo; Salizzoni, Mauro; Gandini, Giovanni

doi:10.1007/s00270-001-0078-7

Cited by 40 publications

(47 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the first results obtained with covered stents do not confirm these expectations yet. 4,25 Finally, a metal stent placement may be considered a complicating factor for further surgical procedures, because it can be difficult to remove because of ingrowth into the wall of the bile duct. 27,28 However, in general, Davidson et al 29 showed in a recent study of 80 patients that those who underwent conversion to CDJ after nonsurgical management of biliary complications appeared to have fewer postoperative complications than those who had an immediate surgical procedure.…”

Section: Choice In Treatment Of Bsmentioning

confidence: 99%

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Roumilhac

Poyet

Sergent

et al. 2003

Liver Transplantation

View full text Add to dashboard Cite

The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n ‫؍‬ 17) or cholangitis (n ‫؍‬ 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n ‫؍‬ 7) or after failure of balloon dilatation (n ‫؍‬ 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n ‫؍‬ 6) or surgery (n ‫؍‬ 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years. (Liver Transpl 2003;9:394-400.) P reviously biliary complications after orthotopic liver transplantation (OLT) have been reported as a perioperative and a middle long-term event in 10% to 40% of patients 1-3 and even nowadays remain an important cause of morbidity after the surgical procedure. 4 Biliary strictures (BS) are reported to occur in 9% to 15% of adult OLT recipients with choledochojejunostomy (CDJ) or choledochocholedochostomy (CDC) and are frequently localized at the anastomosis. 2,5-7 BSs appear also to be a problem in living related liver transplantation. [8][9][10] However, the management of these BSs remains controversial. In a recent survey, 22% of transplant centers in United States reported the use of percutaneous transhepatic management (PTM), whereas 29% chose reoperation and 45% used endoscopic retrograde cholangiography (ERCP). 11 Considering the potential risks of surgical reintervention, we decided in 1990 to treat BSs with PTM as a first approach. The objectives of this retrospective study were to evaluate the longterm outcome and results of systematic PTM for anastomotic BS after OLT. Patients and MethodsBetween July, 1987 and December, 2000, 216 consecutive OLT were performed in our center. To evaluate the middleand long-term outcome of BS, 168 adult patients (85 male and 83 female, age 15 t...

show abstract

Section: Choice In Treatment Of Bsmentioning

confidence: 99%

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Roumilhac

Poyet

Sergent

et al. 2003

Liver Transplantation

View full text Add to dashboard Cite

show abstract

“…Basic technique consists of a initial balloon biliopasty followed by long-term drainage, either endoscopic or percutaneous, during 1 year with frequent changes of drains or stents to avoid silent occlusions [51]. Duration of the long-term drainage is variable from one center to another, some choose to drain only during a short period of time after bilioplasty, but it requires more frequent treatment sessions (from one to three sessions) [53]. The success rate is approximately 70-80% in both endoscopic and percutaneous series and the rate of complications is similar (5-8%).…”

Section: Biliary Complicationsmentioning

confidence: 99%

Interventional radiology in the management of complications after liver transplantation

et al. 2004

View full text Add to dashboard Cite

The arrival of new surgical transplantation techniques, such as split living donor or auxiliary liver transplantation, have increased the incidence of vascular and biliary complications. The causes, symptoms, and diagnostic modalities of arterial, portal caval, and biliary complications are detailed. Interventional techniques, such as balloon angioplasty and stent placement in the arterial and portal tree, as well as biliary interventional techniques, are discussed.

show abstract

“…In addition to these, the dose-area product (DAP) is an indicator of the total patient dose and can serve as a valuable tool for comparison. [3,4]. Il ricorso a procedure interventistiche in pazienti pediatrici sottoposti a trapianto di fegato (OLT, Orthotopic Liver Transplant) consente di affrontare in modo sicuro e poco invasivo le molte complicanze post-chirurgiche, evitando ai pazienti ulteriori interventi chirurgici [5,6].…”

Section: Introductionunclassified

“…Among minor biliary complications, the most common (6%-29%) is the formation of debris, stones and biliary sludge of varying severity [1,2]. Treatment for biliary complications, such as strictures of the biliodigestive anastomosis or lithiasis, by percutaneous biliary drainage and bilioplasty or by lithotripsy is successful in most cases, allowing resolution without surgical revision or repeat transplantation [3,4]. The use of interventional procedures in children who have undergone orthotopic liver transplantation (OLT) allows a safe and minimally invasive approach to many postoperative complications and spares the patients further surgical procedures [5,6].…”

Section: Introductionmentioning

confidence: 99%

Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects

et al. 2008

View full text Add to dashboard Cite

Purpose. This study was undertaken to evaluate patient dose in paediatric liver transplant recipients treated by percutaneous biliary drainage and bilioplasty procedures. Materials and methods. Effective dose rates and entrance skin-dose (ESD) rates per minute of fluoroscopy were measured by using a plexiglas phantom (thickness 10 cm) simulating the patient and by varying the exposure parameters (type of pulsed fluoroscopy, image intensifier diameter, presence of diaphragms) to identify the technique delivering the lowest patient dose. In vivo measurements were performed during three interventional procedures. Results. The effective dose rate proved to be lowest for a particular type of pulsed fluoroscopy, with maximum magnification and with field-limiting diaphragms. The in vivo measurements showed a maximum ESD value of around 50 mGy (the threshold for transient erythema is 2,000 mGy, ICRP 60). The effective dose values were in the range of 0.9-1.5 mSv. Conclusions. We established exposure parameters providing the desired image quality with the lowest dose for the equipment used and for a specific type of interventional procedure. The measured ESD values allow us to exclude the risk of deterministic effects on the skin. The effective dose values and considerations regarding the likelihood of radiation-induced cancer led to the conclusion that the radiological risk for the patient is largely justified by the benefits of these kinds of procedure. Riassunto

show abstract

Role of Interventional Radiology in the Treatment of Biliary Strictures Following Orthotopic Liver Transplantation

Cited by 40 publications

References 16 publications

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Interventional radiology in the management of complications after liver transplantation

Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects

Contact Info

Product

Resources

About