One-step Percutaneous Transhepatic Cholangioscopy Combined With High-frequency Needle-knife Electrotomy in Biliary Strictures After Liver Transplantation

Abstract

BackgroundEndoscopic management is the mainstay for biliary strictures after liver transplantation. However, this method is often failed in cases associated with hepatolithiasis or refractory strictures. The aim of this study is to investigate whether one-step PTC combined with high-frequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management. MethodsClinical data of 14 patients suffering from biliary strictures after liver transplantation from June 2014 to January 2018 were retrospectively analyzed. One-step PTC combined with high-frequency needle-knife electrotomy was used to resolve the strictures. ResultsOne-step PTC was successfully performed in all 14 patients. In 10 of 12 (83.3%) patients with hepatolithiasis, the stones were removed completely. The stricture resolution was achieved in 13 of 14 (92.9%) patients at supporting catheter removal. Three mild adverse events occurred (cholangitis, 2 patient; delayed hemobilia, 1 patient), but were resolved with conservative treatment. The follow up after supporting catheter removal was 15.7 ± 4.5 months. Only 1 patient (8.3%) had stone recurrence and no stenosis occurred during supporting-free follow-up. ConclusionOne-step PTC combined with high-frequency needle-knife electrotomy appears to be a useful for treating biliary strictures after liver transplantation.

Performance and safety of percutaneous cholangioscopy: a systematic review and meta-analysis

“…1 shows the PRISMA flowchart and Table 1 summarizes the main characteristics of the included studies. Only 1 study was prospective, comparing 2 different old-generation cholangioscopes [ 25 ], 1 retrospective compared PerC with double balloon enteroscopy [ 18 ], 5 were retrospective cohorts [ 15 , 16 , 20 , 21 , 23 ] and 7 case series [ 17 , 19 , 22 , 24 , 27 - 29 ]. It is noteworthy that the vast majority of patients (607/682, 89.0%) came from Asian countries.…”

“…Another consideration is the presence of accessible (and usually dilated) intrahepatic ducts and a safe window for initial percutaneous puncture and cholangioscope insertion [ 45 , 46 ], and the decision to proceed with PerC should be based on a multidisciplinary team consensus. The most common practice has been for tract creation and PerC to take place in different sessions, although a single-session approach (with percutaneous transhepatic tract formation and cholangioscopy in the same procedure) does not seem to impact on safety and performance, as indicated by Tao et al in one of the included studies [ 27 ].…”

Percutaneous transhepatic choledochoscopy in the management of hepatolithiasis: a narrative review

“…The dilation should be performed slowly to prevent Gall bladder cardiac syndrome, which refers to the clinical syndrome of diseases of the biliary system (cholecystitis, gallstones) and causes coronary artery contraction through spinal reflex, resulting in insufficient coronary blood supply, which can ultimately lead to angina pectoris, arrhythmia, and even myocardial infarction. Thus, the one-step method has gained widespread use in minimally invasive treatments ( 51 , 52 ). To address the issue of tract immaturity in the one-step method, the insertion of a sheath can be employed.…”

Cholangioscopy for biliary diseases

“…Repeated biopsies of the anastomosis under direct vision using biopsy forceps, until a passage for the guidewire is made, has also been described in difficult cases [61]. High-frequency needle-knife electrotomy guided by percutaneous transhepatic cholangioscopy has also been successful [62]. Finally, cholangioscopy guided corticosteroid injection following balloon dilation of anastomotic strictures could help patients remain stent-free [63].…”