The Balloon Dilatation and Large Profile Catheter Maintenance Method for the Management of the Bile Duct Stricture Following Liver Transplantation

Abstract

ObjectiveWe wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant.Materials and MethodsFrom May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation.ResultsThe initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patient, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up.ConclusionThe percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alternative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.

Percutaneously placed covered retrievable stents for the treatment of biliary anastomotic strictures following living donor liver transplantation

“…Because of their small diameters, some investigators placed 2 or more plastic stents [1][2][3][4] or an indwelling drainage catheter up to 14-18 Fr. 8,17 In our study, the mean duration of treatment was significantly shorter in group 2 than that in group 1. Second, the risk of stent occlusion because of granulation tissue or sludge formation can be avoided because the covered stents are retrievable.…”

Percutaneous intervention for bilioenteric anastomotic strictures: Current strategies and future directions

“…9,12,16,19,20 There has been no documented difference in outcome between short and long dilation times, and several institutions do not specify a specific time on their protocols. Of the largest studies in the past decade, the shortest inflation time of 10-30 seconds was associated with a treatment failure rate of 17%, 15 while the longest inflation time of 3 minutes was associated with a treatment failure rate of …”

“…9 The period of time between initial biliary drainage and balloon dilation varies, with some waiting a period of 1-4 days, 2,14 and others advocating a period of weeks. 2,14,15 Several of the large series evaluating percutaneous dilation over the last decade however routinely conduct their first balloon dilations on the initial day of access. [16][17][18][19] The study by Choo et al 15 used the longest delay of 4-6 weeks between access and initial dilation, though did not have a significantly lower complication rate.…”

“…Because of stricture elasticity, some operators advocate for use of balloon diameters 25%-30% larger than the normal duct. 1,15 Most commonly 8-10 mm 20 are used, though balloon sizes up to 15 mm have been reported without an associated increase in complictions. 1 Short term recurrence of the stricture suggests that the balloon diameter used was too small or the balloon pressure was not great enough to fracture the scar.…”

“…15,[21][22][23] In his initial description, Molnar and Stockum 9 inflated their balloons for approximately 1-3 minutes, which remains the most commonly used inflation time today. 9,12,16,19,20 There has been no documented difference in outcome between short and long dilation times, and several institutions do not specify a specific time on their protocols.…”