Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation

Bourgeois, Nadine; Devière, Jacques; Yeaton, Paul; Bourgeois, Frédéric; Adler, Michael; Stadt, J. Van de; Gelin, Michel; Cremer, Michel

doi:10.1016/s0016-5107(95)70005-6

Cited by 73 publications

(69 citation statements)

References 23 publications

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“…It constituted 28 (40%) of biliary complications in our patient group and half of these presented between 4-12 mo post OLT. Use of ERC for treating anastomotic stricture in older studies had been disappointing [36,37] , however newer studies have reported the efficacy of endoscopic and percutaneous approaches in managing these complications [5,36,[38][39][40] . 2 failures of endoscopic treatment for anastomotic stricture in the present study had to undergo hepaticojejunostomy after 7 and 8 mo of OLT.…”

Section: Discussionmentioning

confidence: 99%

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Shastri

Hoepffner²,

Akoglu³

et al. 2007

WJG

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AIM:To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy. METHODS:Patients who developed biliary complications were analysed in detail for the clinical information, laboratory tests, treatment offered, response to it, follow up and outcomes. The profile of liver enzymes was determined. The safety, efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed.RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1 ± 70.9 U/mL vs 168.5 ± 34.2 U/L, P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs 152.7 ± 21.4 U/L, P = 0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%). Sustained success was achieved in 26 (81%) patients. CONCLUSION:Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early, non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.

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Section: Discussionmentioning

confidence: 99%

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Shastri

Hoepffner²,

Akoglu³

et al. 2007

WJG

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“…Although strictures can present at any time, the overwhelming majority occur within the first year after OLT [1,23] . The mean interval at the time of presentation is 5-8 mo after OLT [3,7,23,34,35] . Recent studies suggest that their prevalence continues to increase with time [36] .…”

Section: Incidence Of Biliary Stricturesmentioning

confidence: 99%

“…Bile leak is an independent risk factor for the development of anastomotic strictures [17] . Later onset anastomotic strictures, most likely indicate fibrotic healing arising from ischemia at the end of the donor or recipient bile duct [34,36,38,40,[43][44][45][46] . Anastomotic strictures are reported to be more common after hepaticojejunostomy than after direct duct-to-duct anastomosis [1,14] .…”

Section: Anastomotic Stricturesmentioning

confidence: 99%

Endoscopic management of biliary strictures after liver transplantation

Williams¹,

Draganov²

2009

WJG

101

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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.

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“…[24][25][26][27] Post-transplant calculi and sludge formation are most likely the result of mechanical obstruction mainly strictures, bacterial infection, 6,24 ischemia, biliary reflux, and biliary mucosal inflammation. The ERCP with sphincterotomy is very successful in removing 90-100% of stones or debris in almost all cases.…”

mentioning

confidence: 99%

“…The ERCP with sphincterotomy is very successful in removing 90-100% of stones or debris in almost all cases. 6,16,24,25 Theories as to the etiology of biliary casts include sloughed biliary epithelium due to prolonged cold storage time or transient or ongoing ischemia, chronic rejection, infection, bile stasis, and alteration of the bile milieu. 16 Biliary cast syndrome describes the cholangiographic findings of multiple fixed filling defects in the intrahepatic or extrahepatic biliary tree that conform to the luminal dimensions of the segment of BD.…”

mentioning

confidence: 99%

Post-liver Transplant Biliary Complications

Atwal¹,

Pastrana²,

Sandhu³

2012

Journal of Clinical and Experimental Hepatology

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Biliary tract complications remain a common source of morbidity and mortality in liver transplant (LT) recipients with an estimated incidence of 5-30% after orthotopic LT and a mortality rate of up to 10%. Biliary complications after LT may be related to various factors including hepatic artery thrombosis or stenosis, ischemia reperfusion injury, immunologic injury, infections, donor pool, and technical issues which include imperfect anastomosis and T-tube-related complications. Management of the detected biliary complications includes nonsurgical and surgical methods. A majority of these post transplant biliary complications can be treated with endoscopic retrograde cholangiography. If unsuccessful, a percutaneous intervention or surgery may be required. In this article, we review the incidence, clinical presentation, and management of the main types of biliary complications. (J CLIN EXP HEPATOL 2012;2:81-85)

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Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation

Cited by 73 publications

References 23 publications

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

Endoscopic management of biliary strictures after liver transplantation

Post-liver Transplant Biliary Complications

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