Pediatric Biliary Interventions

Racadio, John M.; Kukreja, Kamlesh

doi:10.1053/j.tvir.2010.04.007

Cited by 29 publications

(36 citation statements)

References 8 publications

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“…PTC is the gold standard for the diagnosis and treatment of patients with BSs (particularly those with BE anastomoses) . The small liver volume, the possible absence of intrahepatic biliary dilatation, and the possibility of multiple biliary anastomoses render pediatric biliary interventional procedures challenging with the frequent need for long fluoroscopy times and large radiation doses .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

et al. 2014

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The incidence of biliary complications (BCs) after living donor liver transplantation (LDLT) can reach 40%. Published data on the pediatric population are limited, and treatment protocols vary. Our aim was to describe the clinical scenario for BCs and treatment approaches after LDLT. Between October 1995 and December 2012, 489 pediatric LDLT procedures were performed. BCs developed in 71 patients (14.5%). Biliary strictures (BSs) developed in 45 (9.2%) patients, and bile leaks (BLs) developed in 33 patients (6.7%). The BL diagnosis was clinical in all cases, and 69.7% of the patients underwent surgery. Nearly half of the BS cases had clinical features or suggestive ultrasound findings. Liver biopsy findings suggested BSs in 51.7%. Percutaneous transhepatic cholangiography was performed in 95.6% of the BS patients. The success rate was 77% [mean number of percutaneous biliary interventions (PBIs) 5 3.9 6 1.98, median drainage time 5 8 months]. In conclusion, BL patients can be managed with conservative therapy, even though most of these patients will ultimately be treated with surgery. Diagnosing a BS requires a high degree of clinical suspicion because the available resources for its identification can fail in up to 50% of cases. A higher number of PBIs and the use of a drainage catheter for a longer time may be required to achieve better results with this technique. Liver Transpl 20:882-892,

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Section: Discussionmentioning

confidence: 99%

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

et al. 2014

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“…In contrast, solitary biliary strictures are usually associated with the surgical anastomosis. These strictures are more common with choledochocholedochostomy than choledochojejunostomy . The physical examination may be normal.…”

Section: Routine Monitoring and Managementmentioning

confidence: 98%

“…A definitive diagnosis is obtained with contrast radiography or MR cholangiopancreatography combined with MR angiography to assess the hepatic artery. The most usual invasive test is transhepatic cholangiography . Invasive cholangiography and the placement of a biliary stent will decompress the biliary tree.…”

Section: Routine Monitoring and Managementmentioning

confidence: 99%

Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

et al. 2013

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“…13 In pediatric LT recipients, the retrograde endoscopic treatment of BCs is often technically not possible because of the Roux-en-Y biliary reconstruction, even with the implementation of double balloonassisted endoscopic retrograde cholangiography. 16,17 Therefore, most transplant centers consider a percutaneous biliary intervention to be the first-line treatment option for children with biliary stenosis after LT. 18,19 The treatment-related morbidity and mortality, the recurrence rate, the quality of life, and the retransplantation rate are important parameters to be considered in comparisons of therapeutic alternatives. The major complication rate for percutaneous dilatation ranges from 0% to 5.7%, and it is most often conservatively managed.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

et al. 2014

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Biliary complications (BCs) still remain the Achilles heel of liver transplantation (LT) with an overall incidence of 10% to 35% in pediatric series. We hypothesized that (1) the use of alternative techniques (reduced size, split, and living donor grafts) in pediatric LT may contribute to an increased incidence of BCs, and (2) surgery as a first treatment option for anastomotic BCs could allow a definitive cure for the majority of these patients. Four hundred twenty-nine primary pediatric LT procedures, including 88, 91, 47, and 203 whole, reduced size, split, and living donor grafts, respectively, that were performed between July 1993 and November 2010 were retrospectively reviewed. Demographic and surgical variables were analyzed, and their respective impact on BCs was studied with univariate and multivariate analyses. The modalities of BC management were also reviewed. The 1-and 5-year patient survival rates were 94% and 90%, 89% and 85%, 94% and 89%, and 98% and 94% for whole, reduced size, split, and living donor liver grafts, respectively. The overall incidence of BCs was 23% (n 5 98). Sixty were anastomotic complications [47 strictures (78%) and 13 fistulas (22%)]. The graft type was not found to be an independent risk factor for the development of BCs. According to a multivariate analysis, only hepatic artery thrombosis and acute rejection increased the risk of anastomotic BCs (P < 0.001 and P 5 0.003, respectively). Anastomotic BCs were managed primarily with surgical repair in 59 of 60 cases with a primary patency rate of 80% (n 5 47). These results suggest that (1) most of the BCs were anastomotic complications not influenced by the type of graft, and (2) the surgical management of anastomotic BCs may constitute the first and best therapeutic option. Liver Transpl 20:893-903, 2014. V C 2014 AASLD.

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Pediatric Biliary Interventions

Cited by 29 publications

References 8 publications

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

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