Bile duct strictures after liver transplantation: A changing landscape of the Achilles' heel

Koneru, Baburao; Sterling, Mark; Bahramipour, Phillip

doi:10.1002/lt.20753

Cited by 101 publications

(65 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among the etiological factors for anastomotic strictures which appear early in the postoperative period, technical issues appear to be the most important: improper surgical techniques, small caliber of the bile ducts, a mismatch in size between the donor and recipient bile ducts, inappropriate suture material, tension at the anastomosis, excessive use of electrocauterization for control of bile duct bleeding, and infection [25] . Bile leak is an independent risk factor for the development of anastomotic strictures [17] .…”

Section: Anastomotic Stricturesmentioning

confidence: 99%

“…These 2 types of biliary strictures differ in incidence, etiology, presentation, natural history and response to therapy rendering their distinction clinically relevant [25] . Biliary strictures tend to be a common problem after living donor OLT in both the donor and the recipient and are discussed separately.…”

Section: Turesmentioning

confidence: 99%

“…In a study of 64 consecutive patients with suspected biliary complications, MRCP had a sensitivity of 95%, a positive predictive value of 98% and an overall accuracy of 95% compared to ERCP as the reference standard [60] . MRCP is currently considered an optimal noninvasive diagnostic tool for the assessment of biliary complications after OLT [25] . Once MRCP expertise becomes more widely available, it should have an even more prominent role in limiting the role of invasive cholangiography for therapeutic purposes.…”

Section: Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic management of biliary strictures after liver transplantation

Williams¹,

Draganov²

2009

WJG

100

View full text Add to dashboard Cite

Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classified as anastomotic or non-anastomotic strictures according to location and are defined by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is significant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.

show abstract

Section: Anastomotic Stricturesmentioning

confidence: 99%

Section: Turesmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic management of biliary strictures after liver transplantation

Williams¹,

Draganov²

2009

WJG

100

View full text Add to dashboard Cite

show abstract

“…They are usually classified in anastomotic biliary strictures (ABS) and non-anastomotic biliary strictures (NABS). The involved etiological factors seems to be the small bile duct diameter, a big disproportion between graft and recipient bile ducts, the ischemia time, tension on the anastomosis, infection and other technical issues (8) . On the other hand, ischemia related to hepatic artery problems seems to be more related to the occurrence of NABS (2,13) .…”

Section: Discussionmentioning

confidence: 99%

ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

Nacif¹,

Bernardo

et al. 2014

Arq. Gastroenterol.

View full text Add to dashboard Cite

-Context -Biliary strictures after liver transplantation are recognized as its Achilles' heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objective -The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation.

show abstract

“…[1][2][3] However, there is controversy about technical aspects of biliary reconstruction, and factors that may contribute to biliary complications include inadequate surgical technique, small duct size, inappropriate suture material, and tension at the anastomosis. 1,4 Nonrandomized and randomized studies have evaluated the association between fibrin glue application and gastrointestinal anastomotic leak after major visceral surgery. [5][6][7][8][9][10][11] Randomized trials have not supported the benefits of fibrin glue that were reported from nonrandomized trials.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: Fibrin sealants may prevent hemorrhage and biliary leakage after liver resection. We evaluated the effects of topical fibrin glue application on biliary anastomosis in deceaseddonor liver transplant. Materials and Methods: From January 2011 to July 2013, fibrin glue was applied around the biliary anastomosis in 10 patients who had deceased-donor liver transplant (recipients: female, 8 patients; median age, 46.9 y) with end-to-end choledochocholedochostomy in 9 patients and hepaticojejunostomy in 1 patient. Biliary leakage was diagnosed with abdominal computed tomography. Results: Biliary leakage was observed in 1 patient at 18 days after deceased-donor liver transplant with end-to-end choledochocholedochostomy. This was treated with revision laparotomy and reconstruction of the biliary anastomotic leak with a hepaticojejunostomy and placement of an internal stent and fibrin glue; the patient's condition improved. There were no perioperative deaths. Conclusions: In deceased-donor liver transplant, application of fibrin glue at the biliary anastomosis may be associated with a low frequency of postoperative biliary leak.

show abstract

Bile duct strictures after liver transplantation: A changing landscape of the Achilles' heel

Cited by 101 publications

References 19 publications

Endoscopic management of biliary strictures after liver transplantation

Endoscopic management of biliary strictures after liver transplantation

ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

Untitled

Contact Info

Product

Resources

About