Endoscopic management of anastomotic stricture after living-donor liver transplantation

Lee, Dong Hoon; Han, Jimin

doi:10.3904/kjim.2019.044

Cited by 9 publications

(7 citation statements)

References 67 publications

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“…Especially, in recent years, duct-to-duct biliary reconstruction has been preferred over hepaticojejunostomy, because of its simplicity, rapid gastrointestinal recovery, and preservation of physiological bilioenteric continuity. 8,31 This situation allows more active endoscopic access to the biliary system for the management of biliary complications following LDLT. Additionally, LDLT patients generally received ERC first and PTC later, suggesting that majority of hospitals in Korea were using ERC as a first-line treatment and PTC as a rescue or alternative treatment for biliary interventions in LDLT patients.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic and Percutaneous Biliary Interventions after Liver Transplantation: Nationwide Data in Korea

et al. 2022

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contributed equally to this work as first authors.Background/Aims: Biliary complications including biliary strictures and bile leaks are the most common complications that occur after liver transplantation (LT). Endoscopic treatment with endoscopic retrograde cholangiography (ERC) is considered the first-line treatment, and percutaneous transhepatic cholangiography (PTC) can serve as an alternative or rescue therapy. However, nationwide clinical data on the frequency of ERC and PTC following LT have not yet been investigated.Methods: Using the nationwide claims database, we investigated patients who underwent LT between 2012 and 2014 in Korea and followed them until 2015. We analyzed the prevalence and characteristics of patients and biliary procedures, including ERC and PTC implemented after LT.Results: A total of 3,481 patients underwent LT during the 3-year study period. Among them, 3.0% of patients underwent biliary intervention postoperatively during the same hospitalization period, and 21.4% of patients received biliary intervention later on after initially being discharged from the hospital following LT. A total of 16.9% and 12.1% of patients underwent ERC and PTC after LT, respectively. The median period from LT to the first biliary intervention was 7.8 months (interquartile range, 3.5 to 14.6 months), and these patients underwent an average of 3.2±2.8 biliary procedures during the follow-up period. Patients undergoing living donor LT were more than twice as likely to undergo biliary procedures as those undergoing deceased donor LT (25.5% vs 12.1%). Conclusions:Approximately one-fourth of patients in Korea who underwent LT subsequently underwent ERC or PTC. Compared with deceased donor LT patients, those undergoing living donor LT underwent more biliary interventions and were more difficult to treat.

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Section: Discussionmentioning

confidence: 99%

Endoscopic and Percutaneous Biliary Interventions after Liver Transplantation: Nationwide Data in Korea

et al. 2022

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“…In particular, recently, local therapy such as photodynamic therapy and RFA have been performed for biliary tract cancer patients who are not eligible for operation, and PS is more desirable in this case due to requirements for stent replacement (20, 21). In addition, for the treatment of anastomotic stricture after liver transplantation, repeated stent exchange using PS has been performed, and thus replaceable stents are also more useful in such cases (22). Therefore, a novel biliary metal stent with coil-spring structure which is flexible, exchangeable, and has prolonged patency could play an important role.…”

Section: Discussionmentioning

confidence: 99%

Development of novel biliary metal stent with coil-spring structure and its application in vivo swine biliary stricture model

Cho

Lee²,

Choi³

et al. 2023

Front. Oncol.

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BackgroundAs of date, endoscopic biliary stenting with plastic stent (PS) and self-expandable metal stent (SEMS) have been widely used for the palliation of biliary tract strictures. However, these two stents have several limitations regarding the management of biliary strictures caused by intrahepatic and hilar cholangiocarcinoma. PS has short patency and also risks bile duct injury and bowel perforation. SEMS is difficult to revise when occluded by tumor overgrowth. To compensate for such shortcomings, we developed a novel biliary metal stent with coil-spring structure. The aim of this study was to investigate the feasibility and efficacy of the novel stent in a swine model.MethodsThe biliary stricture model was prepared in six mini-pigs using endobiliary radiofrequency ablation. Conventional PS (n=2) and novel stents (n=4) were deployed endoscopically. Technical success was defined as successful stent placement and clinical success was defined as >50% reduction of serum bilirubin level. Adverse events, stent migration, and endoscopic removability for one month after stenting were also assessed.ResultsThe biliary stricture was successfully created in all animals. The technical success rate was 100 %, and the clinical success rate was 50% in the PS group and 75% in the novel stent group. In the novel stent group, the median pre- and post-treatment serum bilirubin levels were 3.94 and 0.3 mg/dL. Stent migration occurred in two pigs and two stents were removed by endoscopy. There was no stent-related mortality.ConclusionsThe newly designed biliary metal stent was feasible and effective in a swine biliary stricture model. Further studies are needed to verify the usefulness of the novel stent in the management of biliary strictures.

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“…When surgical revision is required for patients with a D-D anastomosis, the most commonly performed procedure is a Roux-en-Y HJ. If an HJ was performed initially because of PSC or another bile duct abnormality, then an attempt is made to reposition the bile duct graft to a better vascularized area (49). We performed 14 HJ in 37 BC (38%).…”

Section: Discussion Discussionmentioning

confidence: 99%

Biliary Complications Following Orthotopic Liver Transplantation: the Place of Surgical Reconstruction in the Minimally-Invasive Era

Gil¹,

Figueroa²,

Yance³

et al. 2021

SGO

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Background: Biliary complications are the more frequent problem following liver transplantation (LT) and have been considered the "Achiles´s heel"of this procedure. The aim of this study was to evaluate the rates of biliary complications after LT, the different therapeutic modalities currently available and their outcomes. Methods: A total of 420 LTs performed up to 2020 were retrospectively analyzed. Evaluation factors included MELD score, images, surgical techniques, type of biliary reconstruction and type of complications. We also analyzed the different therapeutic options, and the short and long-term outcome. Results: 417 deceased donors and 3 living donor transplants were performed. Biliary complications occurred in 37 patients (8,8%) -31 strictures (81%), four leaks (11%), one acute biliary peritonitis after T-tube removal (3%) and two patients biliary stones (5%). Biliary complications associated with vascular complications were seen in 10 patients (27%). In general, a minimally invasive management (percutaneous or endoscopic) was the first-line approach. Percutaneous interventional procedures were the treatment of choice in 32/37 patients (86,48%), with a success rate of 67.74% (21/31). Hepaticojejunostomy (HJ) was performed in 14 patients. Overall morbidity rate of surgical reconstruction was 14% (2/14 patients) and perioperative mortality was 7%. The median follow-up was 54,53 months. At follow-up, none of the patients in the HJ group had developed a new stricture. Conclusions: The majority of biliary complications must be treated by minimally invasive approach. However, when those fail,surgical reconstruction allows to avoid future consequences in the graft.

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Endoscopic management of anastomotic stricture after living-donor liver transplantation

Cited by 9 publications

References 67 publications

Endoscopic and Percutaneous Biliary Interventions after Liver Transplantation: Nationwide Data in Korea

Endoscopic and Percutaneous Biliary Interventions after Liver Transplantation: Nationwide Data in Korea

Development of novel biliary metal stent with coil-spring structure and its application in vivo swine biliary stricture model

Biliary Complications Following Orthotopic Liver Transplantation: the Place of Surgical Reconstruction in the Minimally-Invasive Era

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