The role of interventional radiology in biliary complications after orthotopic liver transplantation: a single-center experience

Civelli, Enrico; Meroni, Roberta; Cozzi, G.; Milella, M; Suman, Laura; Vercelli, Ruggero; Severini, A

doi:10.1007/s00330-003-2117-z

Cited by 22 publications

(11 citation statements)

References 19 publications

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“…In our series, PTCD was less successful than ERCP. This difference is in contrast with the observations of others, describing similar or slightly lower success rates 24, 36–38. Most likely, the difference is due to different population of patients referred for PTCD: in our series, mostly patients who were long after liver transplantation, and after previous failure of ERCP.…”

Section: Discussioncontrasting

confidence: 95%

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: Discussioncontrasting

confidence: 95%

Anastomotic biliary strictures after liver transplantation: Causes and consequences

et al. 2006

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“…On the other hand, successful percutaneous management of bile leaks requires long therapy courses. An average duration of PTBD treatment of 6 weeks to 80 days has been reported [14,18]. As seen in our series, Onyx application for the management of bile leaks can shorten therapy courses substantially when combined with PTBD.…”

supporting

confidence: 60%

Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

Uller

Müller-Wille

Loss

et al. 2013

Fortschr Röntgenstr

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Purpose: The management of postoperative bile leakage is challenging especially if the leak rises from the cut surface of the liver and endoscopic treatment fails. Percutaneous transhepatic treatment of bile leaks with biliary drainage is accepted but often requires long-term placement of the drains and is associated with treatment failures. This series evaluates selective embolization of bile ducts with an ethylene vinyl alcohol copolymer (Onyx) in patients with postoperative bile leaks as an alternative treatment option. Materials and Methods: Between January and September 2012, five consecutive patients with persistent postoperative bile leaks underwent percutaneous transhepatic Onyx application and were analyzed regarding procedural management, complications and success rates. Results: The persistent bile leaks were situated at the cystic stump (after cholecystectomy, n?=?2), at the cut surface of the liver (after extended liver resection, n?=?2) and at the surface of the liver after surgical exploration and perihepatic abscess (n?=?1). Bile drainage alone (endoscopic or percutaneous) failed in all patients and open redo-surgery was deemed potentially harmful. Bilomas were externally drained in all patients before Onyx application. For the closure of bile leaks, Onyx was injected through a microcatheter in a previously built coil nest to keep Onyx in place. All bile leaks were initially closed immediately. In the 2nd week after Onyx embolization, 2 patients showed recurrent small bile leaks without clinical symptoms. In the 4th week after Onyx application, all leaks were closed. No complications occurred. Conclusion: All leaking bile ducts were initially closed immediately after Onyx application. In the 2nd week after Onyx application, 2 patients showed small bile leaks without clinical symptoms. All leaks were closed in the 4th week after Onyx application. Key Points: Percutaneous treatment of postoperative bile leaks with Onyx seems to be an effective therapy if endoscopy fails and redo-surgery is deemed harmful. Citation Format:

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“…A combined approach where access to the biliary tree is obtained via a percutaneous transhepatic route followed by "rendezvous" endoscopy 54,75. The use of percutaneous transhepatic drainage achieves success rates of 50% to 75% 76-79. Surgical revision and biliary reconstruction with the formation of a hepaticojejunostomy is indicated when endoscopic or percutaneous treatment fails.…”

Section: Managementmentioning

confidence: 99%

Biliary Strictures after Liver Transplantation

Ryu

Lee²

2011

Gut Liver

124

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Biliary strictures are one of the most common complications following liver transplantation, representing an important cause of morbidity and mortality in transplant recipients. The reported incidence of biliary stricture is 5% to 15% following deceased donor liver transplantations and 28% to 32% following living donor liver transplantations. Bile duct strictures following liver transplantation are easily and conveniently classified as anastomotic strictures (AS) or non-anastomotic strictures (NAS). NAS are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and the need for retransplantation. Current endoscopic strategies to correct biliary strictures following liver transplantation include repeated balloon dilatations and the placement of multiple side-by-side plastic stents. Endoscopic balloon dilatation with stent placement is successful in the majority of AS patients. In patients for whom gaining biliary access is technically difficult, a combined endoscopic and percutaneous/surgical approach proves quite useful. Future directions, including novel endoscopic retrograde cholangiopancreatography techniques, advanced endoscopy, and improved stents could allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. The aim of this review is to detail the present status of endoscopy in the diagnosis, treatment, outcome, and future directions of biliary strictures related to orthotopic liver transplantation from the viewpoint of a clinical gastroenterologists.

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The role of interventional radiology in biliary complications after orthotopic liver transplantation: a single-center experience

Cited by 22 publications

References 19 publications

Anastomotic biliary strictures after liver transplantation: Causes and consequences

Anastomotic biliary strictures after liver transplantation: Causes and consequences

Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

Biliary Strictures after Liver Transplantation

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