Endoscopic treatment in biliary strictures after pediatric liver transplantation

Czubkowski, Piotr; Pertkiewicz, Jan; Markiewicz-Kijewska, Małgorzata; Kaliciński, Piotr; Rurarz, Małgorzata; Jankowska, Irena; Pawłowska, Joanna

doi:10.1111/petr.13271

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…Endoscopic biliary stenting (EBS) drainage with FC-SEMSs or plastic stent (PS) has been reported potentially e cient for ABS after liver transplantation in adults [4] . Although Endoscopy has replaced surgery in most patients with ABS, approximately 10%~20% of patients require surgical revision in the long run [9] . When access to the strictures in the peripheral biliary tree is not possible with ERCP, the rendez-vous technique (PTBD + ERCP) may be useful to insert the stent through the stricture [10] .…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic Endoscopic Retrograde Cholangiopancreatography for Pediatric Hepato-Pancreato-Biliary diseases: A Systematic Review and Meta-analysis

Sun

Zheng

et al. 2022

Preprint

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Background: Hepato-pancreato-biliary (HPB) disease has different causes and types between children and adults, which have been diagnosed increasingly in the pediatric group. Endoscopic retrograde cholangiopancreatography (ERCP) has been gradually considered as a therapeutic method in adults, while in pediatric patients, there are not many reports of its usage. This systematic review and meta-analysis aims to assess the use condition of therapeutic ERCP in the management of pediatric HPB diseases.Methods: This systematic literature search was conducted in the PubMed、Embase、Web of Science and the Cochrane library databases to identify all relevant articles published from inception to February 2022 that evaluated therapeutic ERCP in pediatric patients with Hepato-Pancreato-Biliary diseases. The researchers included studies that patients were less than 18 years old and underwent therapeutic ERCP procedures. A random-effects model was used to analyze the usage rate of therapeutic ERCP-procedures, procedural success rates, adverse events rates, and the rate of different therapeutic procedures. Subgroup analysis, sensitivity analysis, and meta-regression were conducted to analyze the source of heterogeneity.Results: A total of 33 articles were included. After homogenization, the overall usage of therapeutic interventions accounts for 77% (95%CI74%-81%) in all ERCP procedures. After excluding outlier studies, the estimation of therapeutic procedure success rate is 74% (95% CI 69 %-79%), adverse events rate is 8% ( 95% CI 6 %-10%). In our study, stent placement is the most common procedure which makes up 75% (95%CI 65%-86%) of all therapeutic procedures. In addition, the usage proportion of sphincterotomy (ST), stone extraction/removal, bougienage/Balloon dilation is respectively 46% (95% CI 39 %-53%), 34% (95% CI 31%-38%), and 26% (95% CI 22%-29%).Conclusions: ERCP procedure is gradually considered as a therapeutic technique in pediatric patients, the proportion of therapeutic ERCP is 77% of total usage, which is increasing by the year. Meanwhile, its success rate is relatively high. It reflects that this operation modality is promising in the treatment of Hepato-pancreato-biliary disorders and is gradually expanded as more branch technologies are being used. A variety of operations can be achieved through ERCP procedures, and more functions should be developed in the future.

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Section: Discussionmentioning

confidence: 99%

“…Czubkowski et al [9] (2018) Rosen et al [23] (2017) Giefer et al [24] (2015) Dechêne et al [5] (2015)…”

Section: Italymentioning

confidence: 99%

Therapeutic Endoscopic Retrograde Cholangiopancreatography for Pediatric Hepato-Pancreato-Biliary diseases: A Systematic Review and Meta-analysis

Sun

Zheng

et al. 2022

Preprint

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“…In pediatrics, Roux‐en‐Y reconstruction was associated with significantly lower biliary complications compared to a duct‐to‐duct anastomosis 10 . ERCP has been shown to be a successful and safe first‐line treatment option in pediatric patients post‐LT with duct‐to‐duct biliary strictures 14 …”

Section: Discussionmentioning

confidence: 99%

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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“…As biliary atresia is the most common original disease, RY hepaticojejunostomy is a standard procedure for biliary reconstruction in pediatric liver transplantation, and biliary strictures are the most frequent biliary complication, with an incidence of 10-15%. [6][7][8][9][10][11] Therapeutic options for biliary strictures include surgical and nonsurgical interventions. Common nonsurgical interventions are balloon dilatation and stent placement using the endoscopic approach or PTB approach.…”

Section: Introductionmentioning

confidence: 99%

“…However, biliary complications remain the Achilles heel of liver transplantation and can lead to significant morbidity and mortality. As biliary atresia is the most common original disease, RY hepaticojejunostomy is a standard procedure for biliary reconstruction in pediatric liver transplantation, and biliary strictures are the most frequent biliary complication, with an incidence of 10–15% 6‐11 …”

Section: Introductionmentioning

confidence: 99%

Novel technique for recanalization of severe hepaticojejunal obstruction using a transseptal needle in a pediatric liver transplant recipient

Sasaki

Ota

Miyagi

et al. 2021

Pediatric Transplantation

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Background Endoscopic and PTB interventions are common nonsurgical interventions for biliary anastomotic strictures that occur after liver transplantation. When these nonsurgical interventions fail, surgical re‐anastomosis is considered; however, this is quite invasive and can cause additional injury that may lead to graft loss. We report a case in which conventional nonsurgical interventions failed, but a new method that involve the use of a transseptal needle—a device to create a transseptal left‐heart access during cardiac catheter interventions—was successfully used in recanalization of the hepaticojejunal anastomotic obstruction. Case A 21‐year‐old man, who had received living‐donor liver transplantation for biliary atresia at the age of 23 months presented with recurrent cholangitis and liver dysfunction due to a biliary anastomotic stricture of the hepaticojejunostomy. Therapeutic interventions for biliary stricture, including the PTB approach, double‐balloon enteroscopic approach, and rendezvous approach failed. We then performed needle puncture of the anastomotic obstruction using a transseptal needle and succeeded in recanalizing the complete anastomotic obstruction. To perform the procedures safely, we evaluated the organ and needle positions using biplane fluoroscopy and placed a balloon in the afferent jejunal limb as a target for puncture. The 12 Fr catheter via the biliary route was removed 7 months after the procedure, without using a catheter, there was no recurrent stricture or cholangitis for 26 months. Conclusion Using a transseptal needle to manage hepaticojejunal anastomotic obstruction can reduce the number of patients who need surgical re‐anastomosis.

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Endoscopic treatment in biliary strictures after pediatric liver transplantation

Abstract: ERCP is safe and effective in the majority of patients with post-transplant duct-to-duct BS, and it is currently recommended as the first-line treatment.

Cited by 4 publications

References 26 publications

Therapeutic Endoscopic Retrograde Cholangiopancreatography for Pediatric Hepato-Pancreato-Biliary diseases: A Systematic Review and Meta-analysis

Therapeutic Endoscopic Retrograde Cholangiopancreatography for Pediatric Hepato-Pancreato-Biliary diseases: A Systematic Review and Meta-analysis

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

Novel technique for recanalization of severe hepaticojejunal obstruction using a transseptal needle in a pediatric liver transplant recipient

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