Cholangiolithiasis postliver transplantation: Successful treatment utilizing percutaneous transhepatic cholangioscopy and laser lithotripsy

Abstract

Liver transplant is a risk factor for the development of cholangiolithiasis and choledocholithiasis. While usually addressed by endoscopic techniques, percutaneous transhepatic cholangioscopy combined with laser lithotripsy can be considered a suitable alternative option in select patients.A 29-year-old male with a 27-year history of liver transplant presented with new onset of persistent pain localized to the lower abdomen 9 days after a liver biopsy. Abdominal CT scan and MRCP showed large calculi expanding intra- and extrahepatic bile ducts. All intrahepatic ductal calculi were removed after 2 sessions of laser lithotripsy and basket retrieval, while common hepatic duct calculi were anterogradely swept into the jejunum after balloon cholangioplasty of the hepaticojejunal anastomosis. No major procedure-related complications were seen.Percutaneous transhepatic cholangioscopy and choledochoscopy with laser lithotripsy is a minimally invasive and efficient technique for removal of intra- and extrahepatic bile duct stones postliver transplantation.

Percutaneous Transhepatic Single-Operator Cholangioscopy-Guided Intraductal Stone Therapy in a Liver Transplant Patient With Ischemic Cholangiopathy

“… 7 A case report published in 2019 detailed a case in which percutaneous cholangioscopy with laser lithotripsy was used to treat symptomatic cholangiolithiasis in a liver transplant patient with a hepaticojejunal anastomosis stricture. 8 Previous approaches with percutaneous transhepatic cholangioscopy have been traditionally reported with a “daughter” cholangiopancreatoscope or other thin caliber endoscopes which have been used in the technique of percutaneous endoscopic extraction of retained stones. 9 More recently, single-operator cholangioscopy (Spyglass 2) has been used with ERCP to evaluate the biliary system and allow passage of devices such as biopsy forceps, baskets, and EHL probes.…”