Endoscopic versus surgical management of biliary complications – Outcome analysis after 1188 orthotopic liver transplantations

Györi, Georg; Schwarzer, R; Püspök, Andreas; Schöfl, R; Silberhumer, Gerd R.; Langer, Felix B.; Trauner, Michael; Peck‐Radosavljevic, Markus; Berlakovich, Gabriela; Ferlitsch, Arnulf

doi:10.1016/j.dld.2016.05.016

Cited by 10 publications

(6 citation statements)

References 23 publications

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“…One, 14 and eight patients belonged to Child-Turcotte-Pugh (CTP) Class A, B and C respectively (excluding the patient who was transplanted for ALF). Median Model for End-Stage Liver Disease (MELD) score was 15 (13)(14)(15)(16)(17)(18)(19)(20). ABOincompatible transplant was performed in 1 (4.1%) patient, while hepatocellular carcinoma (HCC) was present in 4 (16.6%) patients.…”

Section: Resultsmentioning

confidence: 99%

“…5,9,10 The most common biliary complications are bile leak and strictures. 3,11,12 Traditional management of biliary complications has relied on biliary reconstruction with a hepatico-jejunostomy, but advances in endoscopic and percutaneous therapies have made nonoperative approaches [13][14][15] a commonplace. Endoscopic management of biliary strictures essentially consists of cannulating the stricture with a guide wire, balloon dilation, and placement of one or more stents.…”

Section: Introductionmentioning

confidence: 99%

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Cholangioscopic classification of post‐living donor liver transplantation biliary strictures can predict their natural history and response to therapy

Sharma

Karunakaran

Bansal

et al. 2022

ANZ Journal of Surgery

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Background The study aimed to assess the morphology of post‐living donor liver transplant (LDLT) anastomotic biliary strictures using cholangioscopy and assess the impact of morphology on its prognosis. Methods A single centre, prospective, observational study was conducted at a tertiary care teaching hospital from August 2014 to July 2016. Single operator cholangioscopy (SOC) was used to assess post‐LDLT anastomotic biliary strictures at presentation in 24 patients. Analysis included demographic and biochemical characteristics, time to stricture development, endoscopic procedural details, time to remodelling and development of recurrence on follow‐up. Results Two distinct patterns of strictures were identified, type I with minimal inflammatory changes and type II with severe inflammatory changes. Guidewire cannulation was successful in 23 out of 24 (95.8%) patients. There was no significant difference between the two types of strictures based on aetiology of liver disease, CTP and MELD scores, time taken for the development or laboratory parameters at presentation. However, type II strictures required more sessions of dilatation (4 vs. 2; P = 0.002), longer duration for resolution (282.5 vs. 201.5 days, P = 0.095) and more number of stents. Conclusions Addition of cholangioscopy tends to improve stricture cannulation rates at ERCP. It offers a useful classification of post‐LDLT strictures with prognostic and therapeutic significance. Type II strictures tend to require more sessions of endotherapy than type I strictures over a longer duration for remodelling.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cholangioscopic classification of post‐living donor liver transplantation biliary strictures can predict their natural history and response to therapy

Sharma

Karunakaran

Bansal

et al. 2022

ANZ Journal of Surgery

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“…According to a recent large retrospective study, 24 endoscopic management may be considered a feasible and safe primary approach to biliary complications after LT with a global 80% procedural success and based on its lower invasivity and mortality risk, while keeping the surgical option for failed endoscopic procedures. It is well established that a worse outcome occurs in patients with relaparotomy following LT 25 …”

Section: Discussionmentioning

confidence: 99%

“…9,22 Transhepatic cholangiography is an alternative although limited by a non-dilated intrahepatic biliary tree in most patients and by the availability of an expert interventional radiologist. 23 According to a recent large retrospective study, 24 endoscopic management may be considered a feasible and safe primary approach to biliary complications after LT with a global 80% procedural success and based on its lower invasivity and mortality risk, while keeping the surgical option for failed endoscopic procedures.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of device‐assisted enteroscopy ERCP in liver transplantation: A systematic review and meta‐analysis

Ferretti

Fraquelli

Cantù

et al. 2020

Clinical Transplantation

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Background Enterobiliary anastomoses are the main source of complications after liver transplantation. An endoscopic approach combining device‐assisted enteroscopy and ERCP (DAE‐ERCP) is technically feasible in postsurgical anatomy. Aims This study aimed at assessing the efficacy, feasibility, and safety of DAE‐ERCP in liver‐transplanted patients (LT) and other subsets (non‐LT). Methods A systematic review and meta‐analysis of studies involving DAE procedures in LT patients (between January 2000 and May 2017) was conducted. The main endpoints were as follows: endoscopic, diagnostic, therapeutic, and overall success rates, complications, and the need for surgery. Results A total of 155 studies were retrieved, and 6 relevant trials were analyzed. Overall, 132 subjects (72 LT and 60 non‐LT) undergoing 257 DAE‐ERCP (135 and 122) were included. Complications were rare (4/257), and no deaths occurred. These are the pooled success rates among LT and non‐LT patients: 80%‐100% and 82%‐95% (enteroscopic), 75%‐100% and 89%‐100% (diagnostic), 67%‐100% and 92%‐100% (therapeutic), and 60%‐100% and 79%‐83% (overall results). The requirement for surgery was similar in the two subgroups. Conclusion In managing biliary complications, the high diagnostic and therapeutic success rates of DAE‐ERCP combined with its safety and feasibility encourage its application as a first‐line approach to transplanted patients.

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“…Biliary tract complications represent the most frequent complications in patients after orthotopic liver transplantation (OLT) . They include anastomotic strictures (AS), nonanastomotic strictures (NAS), biliary leak, cast/stone formation and papillary stenosis . Of these, biliary strictures represent the most common biliary complications .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiodrainage in biliary strictures after liver transplantation: Long‐term outcome predictors and influence on patient survival

Heinemann

Tafrishi

Pischke

et al. 2019

Liver International

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Background & Aims: Biliary strictures are common complications after orthotopic liver transplantation. Endoscopic retrograde cholangiography evolved as standard and percutaneous transhepatic cholangiodrainage as alternative therapy. This study analysed predictors of long-term success of biliary strictures after endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage and its impact on patient survival. Methods: All adult patients with biliary strictures receiving endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage between 2009 and 2015 at the University Medical Center Hamburg-Eppendorf were retrospectively analysed. Potential predictors of long-term success (≥12 months) were identified by univariate and logistic regression analyses. Patient survival was analysed by Kaplan-Meier method and log-rank test. Results: Hundred and sixteen patients were treated with endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage, including 67 patients with anastomotic strictures, 22 with nonanastomotic strictures and 27 with both stricture types. Eighty-five patients received endoscopic retrograde cholangiography, 17 percutaneous transhepatic cholangiodrainage and 14 both techniques.Long-term success was achieved in 60 patients (52%). Predictors of treatment failure were a preinterventional C-reactive protein >8 g/dL in anastomotic strictures (P = 0.039) and a body mass index ≤21 kg/m 2 in nonanastomotic strictures (P = 0.021).In patients who received endoscopic retrograde cholangiography only, balloon dilatation of anastomotic strictures with larger diameters favoured success (P = 0.015). Achievement of long-term success was associated with prolonged patient survival inPlatelets (10 3 /µL) 204 (21-658) Alanine aminotransferase (U/L) 73 (12-661) Aspartate aminotransferase (U/L) 54 (14-297) Gamma glutamyl transferase (U/L) 472 (31-3111) Alkaline phosphatase (U/L) 354 (64-2270) Bilirubin (g/dL) 1 (0.2-26) Creatinine (mg/dL) 1 (1-4) C-reactive protein (mg/L) 15 (1-185) International normalised ratio 1 (1-2) Continuous variables are reported as median and range. Categorical variables are provided as counts and percentages. * P < 0.05. ** P < 0.01.

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Endoscopic versus surgical management of biliary complications – Outcome analysis after 1188 orthotopic liver transplantations

Cited by 10 publications

References 23 publications

Cholangioscopic classification of post‐living donor liver transplantation biliary strictures can predict their natural history and response to therapy

Cholangioscopic classification of post‐living donor liver transplantation biliary strictures can predict their natural history and response to therapy

Efficacy and safety of device‐assisted enteroscopy ERCP in liver transplantation: A systematic review and meta‐analysis

Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiodrainage in biliary strictures after liver transplantation: Long‐term outcome predictors and influence on patient survival

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