Endoscopic management of biliary strictures after duct-to-duct biliary reconstruction in right-lobe living-donor liver transplantation

Abstract

Endoscopic placement of an inside stent is useful for treating biliary strictures in patients who have undergone right-lobe LDLT with duct-to-duct reconstruction.

New Strategy in Cases of Failed Endoscopic Intervention of Biliary Strictures after Living Donor Liver Transplantation: Percutaneous Transhepatic Biliary Stent Insertion and Subsequent Endoscopic Treatment

“…The causes for the low success rates of endoscopic intervention therapy are the presence of multiple ductal anastomoses, smaller size, peripheral location, and a pouched shape of biliary anastomosis (3,6,14,16). In right hemi-liver-LDLT patients with duct-to-duct biliary reconstruction, most anastomotic biliary strictures develop in a fork-shaped or trident-shaped fashion even if the biliary system had been reconstructed in a single duct-to-duct fashion (15). In this regard, endoscopic biliary stenting appears to be efficacious for treating multibranched biliary strictures because multiple stenting permits the drainage of each segmental branch of the stricture.…”

Wire-guided exchange of an inside stent for complex biliary stricture after living donor liver transplantation

“…Endoscopic stent insertion is considered to be the first-line treatment for this complication (2,3). To reduce duodenobiliary reflux, plastic stents are placed above the intact papilla ('inside stent') in some centers (2)(3)(4).…”

“…Endoscopic stent insertion is considered to be the first-line treatment for this complication (2,3). To reduce duodenobiliary reflux, plastic stents are placed above the intact papilla ('inside stent') in some centers (2)(3)(4). Since the anastomosis of LDLT is more peripheral and more complex, compared with deceased donor liver transplantation, we have occasionally encountered technical difficulties in re-passing a guidewire through the anastomotic biliary stricture at the time of inside stent exchange.…”

Ischemic Type Biliary Lesions

“…In most cases, cholangiography must be performed percutaneously as transhepatic punction and instillation of contrast fluid in the biliary system ( fig. 6) [2,35]. Elevated pressure and subsequent dilatation of the biliary tract may facilitate the examination.…”

“…Thus, the main advantages of choledocho-choledochostomy comprise the integrity of anatomic barrier regarding the reflux of intestinal flora to a great extent, better technical feasibility than Roux-en-Y and physiological condition for an endoscopic access [35,58]. Choledocho-choledochostomy in side-to-side-technique seems to be the most reliable reconstructive method [22,59].…”