A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation

Abstract

Biliary complications remain a major concern after living donor liver transplantation. We describe a pediatric case who underwent a successful endoscopic balloon dilatation of biliary-enteric stricture following living donor liver transplantation using a newly developed method of enteroscopy. The 7-year-old boy with late biliary stricture of choledochojejunostomy was admitted 6 years after transplantation. Since percutaneous transhepatic cholangiography was technically difficult in this case, endoscopic retrograde cholangiography was performed using a double-balloon enteroscope under general anesthesia. The enteroscope was advanced retrograde through the duodenum, jejunum, and the leg of Roux-Y by the doubleballoon method, and anastomotic stricture of choledochojejunostomy was clearly confirmed by endoscopic retrograde cholangiography and endoscopic direct vision. Balloon dilatation was performed and the anastomosis was expanded. Restenosis was not noted as of 2 years after the treatment. In conclusion, endoscopic balloon dilation of biliary-enteric anastomotic stricture using a new enteroscopic method can be regarded as an alternative choice to percutaneous transhepatic management and surgical re-anatomists. (Liver Transpl 2005;11:1608-1610.)

Endoscopic management of biliary strictures after living donor liver transplantation

“…Deep enteroscopy techniques (double-balloon enteroscopy, single-balloon enteroscopy, and spiral overtube-assisted enteroscopy), however, enable access to the anastomosis and subsequent endoscopic management of biliary strictures in LDLT patients with RYHJ, thus obviating the need for more invasive interventions [78,[101][102][103][104]. Sanada et al evaluated the efficacy of double-balloon enteroscopy in 25 pediatric LDLT patients with bilioenteric anastomotic stricture [102].…”

The use of the double-balloon enteroscope for endoscopic retrograde cholangiopancreatography and biliary stent placement after Roux-en-Y hepaticojejunostomy

“…The 2.8−mm working chan− nel allows for the introduction of conven− tional accessories, provided they have 230 cm length available. Choledochojeju− nostomy balloon dilation using DBE was first reported after living donor liver transplantation [4]. In one multicenter study, two patients successfully under− went DBE ERCP and biliary balloon dila− tion after Roux−en−Y reconstruction [5].…”

Endoscopic management of post-liver transplant biliary complications

“…The median duration of plastic stent patency is around 3 mo (range 2-4 mo), as they are prone to debris deposition in their lumen resulting in obstruction, and risk of cholangitis. This approach has a success rate of 75% to 91% according to different deep ERC can be performed even in patients with Roux-en-Y hepaticojejunostomy [49,50] . A large, multicentric study by Shah et al [51] showed that in patients with surgically altered biliary anatomy, SBE, DBE or rotational over-tube enteroscopy can be used to perform ERC successfully in 88% of patients in whom papilla is reachable.…”