Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation

Harputluoğlu, Murat; Demirel, Ulvi; Çalışkan, Ali Rıza; Selimoğlu, Ayşe; Bilgiç, Yılmaz; Aladağ, Murat; Erdoğan, Mehmet Ali; Dertli, Ramazan; Atayan, Yahya; Yilmaz, Sezai

doi:10.1007/s00423-019-01804-y

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Single‐center reports of biliary stricture management have stated high success rates—all with variable approaches and time intervals between procedures, highlighting the inability for the literature to support a single approach. ( 3,12‐14 ) In this study, the intervals were longer with ERCP than with PTC. Single‐center studies have also reported longer time intervals between ERCP procedures, ranging between 2 and 3 months, ( 10,15 ) while studies employing PTC have reported shorter time intervals.…”

Section: Discussionmentioning

confidence: 53%

North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry

et al. 2022

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Biliary strictures affect 4%‐12% of pediatric liver transplantations. Biliary strictures can contribute to graft loss if left untreated; however, there remains no consensus on the best course of treatment. Study objectives included analyses of outcomes associated with biliary stricture management strategies via percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), or surgery. We identified pediatric liver transplantation recipients (2011‐2016) with biliary strictures from the Society of Pediatric Liver Transplantation (SPLIT) registry and retrieved imaging, procedural, and operative reports from individual centers. Subanalyses were performed to specifically evaluate PTC and ERCP for “optimal biliary outcome” (OBO), defined as graft survival with stricture resolution and without recurrence or surgery. A total of 113 children with a median follow‐up of 3.9 years had strictures diagnosed 100 days (interquartile range, 30‐290) after liver transplantation; 81% were isolated anastomotic strictures. Stricture resolution was achieved in 92% within 101 days, more frequently with isolated anastomotic strictures (96%). 20% of strictures recurred, more commonly in association with hepatic artery thrombosis (32%). Patient and graft survival at 1 and 3 years were 99% and 98% and 94% and 92%, respectively. In a subgroup analysis of 79 patients with extrahepatic strictures managed by PTC/ERCP, 59% achieved OBO following a median of 4 PTC, and 75% following a median of 3 ERCP (P < 0.001). Among patients with OBO, those with ERCP had longer time intervals between successive procedures (41, 47, 54, 62, 71 days) than for PTC (27, 31, 36, 41, 48 days; P < 0.001). Allograft salvage was successful across all interventions. Stricture resolution was achieved in 92%, with 20% risk of recurrence. Resolution without recurrence was highest in patients with isolated anastomotic strictures and without hepatic artery thrombosis.

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Section: Discussionmentioning

confidence: 53%

North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry

et al. 2022

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“…In the pediatric population, the existing pool of data on pediatric biliary complications is relatively small and heterogeneous. Different techniques and treatment algorithms are used at different centers, and encompass endoscopic, percutaneous, and surgical routes and are also likely subject to variability in their transplant populations 6,10,11,14–16,26,31,33,35–38,41–66 . A brief summary of the existing literature regarding the outcomes of pediatric patients who underwent non‐surgical biliary complication management after liver transplant is provided in Table 6.…”

Section: Discussionmentioning

confidence: 99%

Non‐operative management of biliary complications after Liver Transplantation in pediatric patients: A 30‐year experience

Lee

Lehrman

Perito

et al. 2021

Pediatric Transplantation

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Background To evaluate the efficacy of percutaneous and endoscopic therapeutic interventions for biliary strictures and leaks following LT in children. Methods Retrospective analysis of 49 consecutive pediatric liver transplant recipients (27 girls, 22 boys, mean age at transplant 3.9 years) treated at our institution from 1989 to 2019 for biliary leak and/or biliary stricture was performed. Minimally invasive approach was considered clinically successful if it resulted in patency of the narrowed biliary segment and/or correction of the biliary leak. Results Forty‐two patients had a stricture at the biliary anastomosis; seven had a biliary leak. After an average 13.8 years of follow‐up, long‐term clinical success with minimally invasive treatment (no surgery or re‐transplant) was achieved for 24 children (57%) with biliary stricture and 4 (57%) with biliary leaks. Eight patients required re‐transplant; however, only one was due to failure of both percutaneous and surgical management. For biliary strictures, failure of non‐surgical management was associated with younger age at stricture diagnosis (p < .02). Conclusions Percutaneous and endoscopic management of biliary strictures and leaks after LT in children is associated with a durable result in >50% of children.

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“…Meanwhile, the corresponding rate for adults was reported 26.9% [16]. However, A more recent study indicated a 12.7% rate of biliary complication in a group of 298 LDLT pediatrics, 75% of which had undergone duct to duct anastomosis [17]. The prevalence of this complication was lower in patients who have undergone Roux-en-Y surgery (12.6%) compared with the duct to duct anastomosis group (20.2%).…”

Section: Discussionmentioning

confidence: 96%

“…75% из которых выполнен анастомоз «проток в проток»[17]. Частота этого осложнения была ниже у пациентов, которым выполняли гепатикоеюностомию на петле по Ру (12,6%) в сравнении с группой, которой выполнен анастомоз методом «проток в проток» (20,2%).…”

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Liver transplantation in pediatric patients under 15 kg; duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses

Dehghani

Ataollahi

Salimi

et al. 2021

RJTAO

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Back ground. Liver transplantation is an effective treatment for acute or chronic liver failure and metabolic liver disease, which is associated with good quality of life in over 80 percent of recipients. We aimed to evaluate outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in pediatric liver transplant recipients below 15-kg.Methods. In this single-center retrospective study, all children less than 15 kg that have undergone liver transplantation at Nemazee Hospital Organ Transplant Center affiliated with Shiraz University of Medical Sciences from 2009 till 2019, were enrolled. Over a 10-yr period, 181 liver transplants were performed in patients with two techniques including duct-to-duct (Group 1) vs. Roux-en-Y hepaticojejunostomy biliary anastomoses (Group 2). All data was collected from patients’ medical records, operative notes, and post-transplant follow up notes. Data was analyzed by SPSS software V21.Results. Overall, 94 patients had duct to duct anastomosis (group 1) and 87 cases had Roux-en-Y hepaticojejunostomy (group 2). The mean age of the patients was 2.46 ± 1.5. The most common underlying diseases was biliary atresia (32%). The most prevalent complication after the surgery was infection in both groups. cardiopulmonary problems were significantly higher in group 2 (24.1% vs 4.3%) (p < 0.001). The rate of infection was significantly higher in group 2, as well.Conclusion. Our study showed a relatively high rate of post-operative infection which was the most among patients who had undergone Roux-en-Y hepaticojejunostomy. Except from biliary complications which were mostly observed in DD group, other complications were more common among Roux-en-Y group.

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Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation

Cited by 5 publications

References 32 publications

North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry

North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry

Non‐operative management of biliary complications after Liver Transplantation in pediatric patients: A 30‐year experience

Liver transplantation in pediatric patients under 15 kg; duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses

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