Balloon Dilatation of Biliary–Enteric Strictures in Children

Lorenz, Jonathan M.; Denison, Gregory L.; Funaki, Brian; Leef, Jeffrey A.; Ha, Thuong Van; Rosenblum, Jordan D.

doi:10.2214/ajr.184.1.01840151

Cited by 44 publications

(47 citation statements)

References 7 publications

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“…The major complication rate for percutaneous dilatation ranges from 0% to 5.7%, and it is most often conservatively managed. 18,20 In a large series of biliary drain placements (n 5 120) for transplant-related biliary strictures in children, Lorenz et al 21 observed a major complication rate of 1.7% and a minor complication rate of 10.8%. The associated 30-day mortality rate was 2.5% (3/120).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, comparisons with nonsurgical classifications used to define morbidity and mortality (eg, the Society of Cardiovascular and Interventional Radiology guidelines regarding major and minor complications) must be interpreted with caution. A literature review of singlecenter reports illustrated that recurrence rates after percutaneous treatments for anastomotic BCs after pediatric LT varied from 0% to 66% 18,20,[22][23][24][25][26][27] (see Table 8). The recurrence rate in this series of 1-stage surgically treated anastomotic BCs was 20% with a mean follow-up of 92 months (range 5 1-210 months).…”

Section: Discussionmentioning

confidence: 99%

“…Cholangitis was defined as a bile infection manifesting clinically with a combination of symptoms (fever, jaundice, and/ or abdominal pain) and with biochemical alterations (predominantly in alanine aminotransferase, gammaglutamyltransferase, and/or direct bilirubin) but not necessarily positive radiological findings (eg, biliary dilatation). Complications were considered to be early BCs (20)if they occurred within the first 3 months after transplantation and as late BCs if they occurred after the first 3 months. Table 4 presents a detailed classification of the BCs elaborated in this study.…”

Section: Diagnosis and Classification Of Bcsmentioning

confidence: 99%

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Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

et al. 2014

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Biliary complications (BCs) still remain the Achilles heel of liver transplantation (LT) with an overall incidence of 10% to 35% in pediatric series. We hypothesized that (1) the use of alternative techniques (reduced size, split, and living donor grafts) in pediatric LT may contribute to an increased incidence of BCs, and (2) surgery as a first treatment option for anastomotic BCs could allow a definitive cure for the majority of these patients. Four hundred twenty-nine primary pediatric LT procedures, including 88, 91, 47, and 203 whole, reduced size, split, and living donor grafts, respectively, that were performed between July 1993 and November 2010 were retrospectively reviewed. Demographic and surgical variables were analyzed, and their respective impact on BCs was studied with univariate and multivariate analyses. The modalities of BC management were also reviewed. The 1-and 5-year patient survival rates were 94% and 90%, 89% and 85%, 94% and 89%, and 98% and 94% for whole, reduced size, split, and living donor liver grafts, respectively. The overall incidence of BCs was 23% (n 5 98). Sixty were anastomotic complications [47 strictures (78%) and 13 fistulas (22%)]. The graft type was not found to be an independent risk factor for the development of BCs. According to a multivariate analysis, only hepatic artery thrombosis and acute rejection increased the risk of anastomotic BCs (P < 0.001 and P 5 0.003, respectively). Anastomotic BCs were managed primarily with surgical repair in 59 of 60 cases with a primary patency rate of 80% (n 5 47). These results suggest that (1) most of the BCs were anastomotic complications not influenced by the type of graft, and (2) the surgical management of anastomotic BCs may constitute the first and best therapeutic option. Liver Transpl 20:893-903, 2014. V C 2014 AASLD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Diagnosis and Classification Of Bcsmentioning

confidence: 99%

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Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

et al. 2014

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“…Although efficacy and safety of these biliary interventions are well established in adults 2,7 and children with malignant obstructions 8,9 , there is less experience of percutaneous transhepatic biliary interventions in benign diseases of children 10 . In this article, we aimed to evaluate the safety and efficacy of percutaneous transhepatic biliary interventions in benign diseases of children.…”

Section: Introductionmentioning

confidence: 99%

Çocukluk Çağı Benign Hastalıklarında Perkütan Transhepatik Biliyer Girişimler

Çeliktaş¹

2015

Cukurova Medical Journal

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Purpose: Percutaneous transhepatic biliary interventions are performed safely and effectively in adults. There is less experience of these interventions in benign diseases of children. We aimed to evaluate the safety and efficacy of percutaneous biliary interventions in benign diseases of children. Materials and Methods: In this retrospective study, percutaneous biliary interventions were performed in fifteen children with a mean age of 10.2 years (range 14 days-14 years). Patients presented with jaundice (n=5) and/or cholangitis (n=10). Percutaneous transhepatic biliary drainage (PTBD) performed in 10 patients, PTBD plus balloon dilation in 3, percutaneous cholecystostomy (PC) in 1, PTBD following PC in 1. Results: All procedures were technically successful. No procedure-related mortality occurred in patients. Serum bilirubin levels returned to normal or near normal in ten of twelve cases. Preexisting cholangitis and acute cholecystitis resolved in all patients. Six patients underwent surgery following percutaneous management. Nine patients cured primarily with percutaneous interventions with no further treatment. Conclusion: Percutaneous biliary interventions can be performed effectively in benign diseases of children. It can be performed either as a primary treatment modality or as a bridge prior to surgery. In most of cases, percutaneous treatment is sufficient and unnecessary surgery is prevented.

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“…Percutaneous treatment of biliary complications is also the initial approach in children who have undergone OLT [7,8]. However, reduced patient cooperation, long fluoroscopy times and the need for repeat procedures demand that special attention be paid to radiation protection issues, in consideration of the higher sensitivity to ionising radiation and the longer life expectancy of paediatric patients.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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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

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Balloon Dilatation of Biliary–Enteric Strictures in Children

Abstract: Balloon dilatation is a safe and effective treatment for biliary-enteric strictures following pediatric liver transplantation.

Cited by 44 publications

References 7 publications

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

Çocukluk Çağı Benign Hastalıklarında Perkütan Transhepatik Biliyer Girişimler

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

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