Endoscopic Management of Biliary Issues in the Liver Transplant Patient

Crismale, James F.; Ahmad, Jawad

doi:10.1016/j.giec.2018.11.003

Cited by 18 publications

(21 citation statements)

References 75 publications

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“…Biliary complications occur in 10%‐40% of patients in the post‐LT setting, causing significant morbidity and in some cases threatening graft and patient survival 2‐5 . These complications include NAS, AS, sphincter of Oddi dysfunction, anastomotic leaks, stones, sludge, and casts (the most common of which are leaks, strictures, and stones) 2‐8 . Stones independently are a relatively rare complication, occurring in 2%‐6% of LT recipients 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of biliary complications post‐LT may be surgical, endoscopic, or percutaneous 2,7 . Historically, many biliary complications were managed surgically, but recently, less invasive percutaneous and endoscopic approaches have become commonplace 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Historically, many biliary complications were managed surgically, but recently, less invasive percutaneous and endoscopic approaches have become commonplace 7 . Most literature available outlines the use of endoscopic interventions in the management of these complications 2,4,5,7,8 In one study of 33 patients who underwent ERCP for biliary stone removal following LT, biliary stones were successfully extracted in 50% of patients with DDLT and AS, in 60% of patients following DDLT and NAS, in 81.5% of patients with LDLT and AS, and in 60% of patients with LDLT and NAS 4 . Stone extraction was more difficult by ERCP with NAS compared to AS 4 .…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous removal of biliary stones post‐liver transplant in a pediatric patient: Case report and review of the literature

Rohringer

Hannick

Lorenzo

et al. 2020

Pediatric Transplantation

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This is a case of a girl born with citrullinemia diagnosed in her firstweek of life after presenting with hyperammonemia and encephalopathy. At 1 year of age, she received a deceased donor segmental split left LT due to recurrent and refractory metabolic decompensations despite optimal medical and dietary management. During the initial LT, a duct-to-duct anastomosis was performed. One week later, the patient required a revision of the biliary anastomosis due to a bile leak and subphrenic abscess. During revision, the end-toend anastomosis was taken down, and a bilio-enteric anastomosis was created using a Roux-en-Y hepatojejunostomy. A surgical drain remained in place for 1 month, after which a cholangiogram revealed stenosis of the anastomosis with a biliary stricture. The biliary drain AbstractThis case report describes an 8-year-old girl who underwent a segmental LT for a primary diagnosis of citrullinemia at the age of 12 months. She presented with cholangitis secondary to stenosis of the biliary-enteric anastomosis. MRI revealed dilatation of intrahepatic bile ducts associated with multiple stones. An endoscopic approach failed to decompress the bile ducts and remove the stones. A percutaneous approach was then undertaken. After placement of a temporary external biliary drain for 12 days, a 26 French sheath was placed to access the bile ducts. Using a 14Fr flexible cystoscope, 80%-90% of the biliary stones were removed. This was followed by antegrade balloon dilatation of the biliary-enteric anastomosis. Two months later, the procedure was repeated, resulting in complete clearance of the biliary stones. An internal-external biliary drain was maintained in placed for 10 months. The patient has been asymptomatic, with no evidence of stone recurrence for 13 months after drain removal. Percutaneous biliary stone removal is commonly performed in adults with non-transplanted livers, especially in complex cases, and has also been shown to be successful in the pediatric population. However, it is rarely reported in transplanted livers in adults, and to the best of our knowledge, no pediatric cases have been reported. This case illustrates that this technique can be successfully utilized in pediatric LT patients. K E Y W O R D S biliary complications, biliary stones, citrullinemia, liver transplantation, pediatric liver transplant, percutaneous stone removal How to cite this article: Rohringer TJ, Hannick JH, Lorenzo A, Avitzur Y, Temple M, Parra DA. Percutaneous removal of biliary stones post-liver transplant in a pediatric patient: Case report and review of the literature. Pediatr Transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Percutaneous removal of biliary stones post‐liver transplant in a pediatric patient: Case report and review of the literature

Rohringer

Hannick

Lorenzo

et al. 2020

Pediatric Transplantation

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“…ese complications often lead to increased morbidity as well as reduced graft and patient survival [6]. Currently, endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are the main techniques used to diagnose and treat biliary complications in liver transplant patients [7].…”

Section: Introductionmentioning

confidence: 99%

“…Biliary complications such as biliary leakage, biliary stones, or bile duct (anastomotic or nonanastomotic) strictures affect 10 to 25% of adult liver transplant recipients [ 1 – 5 ]. These complications often lead to increased morbidity as well as reduced graft and patient survival [ 6 ]. Currently, endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are the main techniques used to diagnose and treat biliary complications in liver transplant patients [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Morphological Characteristics of Biliary Strictures after Liver Transplantation Visualized Using SpyGlass™ Cholangioscopy

Chokpapone

Murray

Mehta

et al. 2020

Case Reports in Hepatology

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Biliary complications following liver transplant are common. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) are the main techniques used to diagnose and treat biliary complications; however, these techniques have limits to the depth of visualization. In this report, we present five cases of orthotopic liver transplant patients with biliary complications that underwent ERCP- or MRCP-guided cholangioscopy with the SpyGlass™ DS Direct Visualization System (SDDVS). The SDDVS allowed for the visualization of the morphological characteristics of biliary strictures, and images collected using the SDDVS allowed for four of the cases to be treated endoscopically. Our findings suggest that cholangioscopy with the SDDVS is a promising method to guide the endoscopic treatment of biliary complications after liver transplantation.

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