Management of biliary complications after orthotopic liver transplantation: The role of endoscopy

Abstract

Biliary complications are significant causes of morbidity and mortality after orthotopic liver transplantation (OLT). The estimated incidence of biliary complications after OLT ranges between 10%-25%, however, these numbers continue to decline due to improvement in surgical techniques. The most common biliary complications are strictures (both anastomotic and non-anastomotic) and bile leaks. Most of these problems can be appropriately managed with endoscopic retrograde colangiography (ERC). Other complications such as bile duct stones, bile casts, sphincter of Oddi dysfunction, and hemobilia, are less frequent and also can be managed with ERC. This article will review the risk factors, diagnosis, and endoscopic management of the most common biliary complications after OLT.

The application of SpyScope® technology in evaluation of pre and post liver transplant biliary problems

“…Biliary problems are a known cause of morbidity in both pre-and post-OLTx patients (2). Every effort should be performed for definitive diagnosis of bile duct abnormalities, which is essential in the planning of therapy in this setting.…”

Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers

“…Among the different types of biliary adverse events after LT, bile leak is the second most 1 frequent with an incidence of 2% to 25%. [1][2][3][4][5][6][7] Bile leaks are classified as anastomotic, T-tube-related, cystic duct-related or, in the case of living donor liver transplants (LDLT), cut-surface-related. 6 Common risk factors for the development of bile leaks are related to surgical technique, hepatic artery thrombosis, LT from donors after cardiac death, ABO mismatch, prolonged warm and cold ischemia times, and T-tube use.…”

“…9 Endoscopic retrograde cholangiopancreatography (ERCP) is also very effective and highresolution rates are near 90%. [1][2][3][4][6][7][8] A variety of ERCP techniques have been described for managing leaks, including: nasobiliary drainage, [10][11][12][13] sphincterotomy alone, [14][15][16][17] plastic biliary stent placement with or without out sphincterotomy, 3,4,6,7,[18][19][20][21][22][23][24] and placement of fully covered self-expandable metallic stents (FCSEMS). [25][26][27] Regardless of method used, the suggested mechanism of healing relates to the equalization of pressures in the bile duct and duodenum, which allows antegrade bile flow into the duodenum.…”

Biliary Complications in Liver Transplantation

“…[ Figure 5] The performance of sphincterotomy and biliary stenting often induces the closure of fistulas in most cases, with mean treatment duration ranging from 60 to 90 days according to some series (Londono et al 2008). Another option is the passage of naso-biliary tubes, with the advantage of easy access to perform contrast-enhanced studies of the biliary tract.…”