Benign Postoperative Biliary Strictures

Pitt, Henry A.; Kaufman, Stephen L.; Coleman, JoAnn; White, Robert I.; Cameron, John L.

doi:10.1097/00000658-198910000-00001

Cited by 198 publications

(112 citation statements)

References 23 publications

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“…Pitt et al 32 established a 88% success rate after 4 years for postoperative benign stricture management in patients who did not undergo transplantation, which appears to be a better result compared with balloon dilatation. Kuo et al 30 reported a 89% success rate after 1 year, compared with 45% success rate for ERCP or PTC.…”

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

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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...

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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

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“…In general, it is recommended to maintain tubes for 3 to 6 months. In most complex cases, up to 12 months of stenting can be necessary [22,32,33]. The authors who use stents selectively consider that they are unnecessary if a tension-free anastomosis with wide stoma and good blood supply is accomplished.…”

Section: Figurementioning

confidence: 99%

Iatrogenic Biliary Strictures: Surgical Experience with 39 Patients

et al. 1997

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“…The success rate and long term results of percutaneous treatment of benign strictures are reviewed and discussed in a number of articles 1,5,7,9,[11][12][13][14][15][16] . The percutaneous treatment of these strictures by dilatation has a success rate from 60 to 90 % 1 .…”

Section: Long-term Resultsmentioning

confidence: 99%

Percutaneous Treatment of Benign Biliary Strictures and Biliary Manometric Perfusion Test

Thomas¹,

Köcher²

2007

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background: Benign biliary strictures are usually treated surgically or endoscopically. When these strictures are not accessible by endoscope or when open repair is not possible, percutaneous dilatation treatment is indicated. The effi cacy of treatment is usually evaluated by clinical trial which includes leaving a small non-functional catheter in situ and following liver function tests. The evaluation may be eff ectively done by the biliary manometric perfusion test.Aim: The aim of this paper is to emphasize the importance of percutaneous dilatation treatment of benign biliary strictures with focus on the role of the biliary manometric perfusion test and its future prospects.Methods and Results: Based on the literature and our own experience, this article gives a short overview of percutaneous treatment of benign biliary strictures, indications, techniques, complications and results. The treatment of these strictures has an overall success rate between 60 to 90 %. This article also explains the biliary manometric test, the technique and its importance in evaluation of treatment success.Conclusion: Benign biliary strictures of the hepatic duct junction or bilio-enteric anastomosis are diffi cult to treat surgically and are endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long term externalinternal drainage is feasible in the majority of these patients. It is minimally invasive, safe and eff ective. The evaluation of the treatment success may be more eff ectively done by the manometric perfusion test. It is easy, reliable, less time-consuming giving immediate results, and relatively safe.

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Benign Postoperative Biliary Strictures

Cited by 198 publications

References 23 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

Iatrogenic Biliary Strictures: Surgical Experience with 39 Patients

Percutaneous Treatment of Benign Biliary Strictures and Biliary Manometric Perfusion Test

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