Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation

Abstract

Endoscopic treatment has largely replaced surgery as the initial treatment for biliary strictures following living donor liver transplantation; however, this treatment is nearly impossible in patients who have previously undergone hepaticojejunostomy (HJ). We therefore retrospectively evaluated the efficacy of percutaneous transhepatic treatment in patients who developed HJ strictures following living donor liver transplantation. Percutaneous transhepatic biliary drainage and subsequent balloon dilation of biliary strictures were performed on 83 patients. Serial exchanges of drainage tubes with larger diameters up to 14 Fr were performed at 4-week intervals. Drainage tubes were removed if follow-up cholangiography revealed fluent passage of the contrast medium without recurrence of symptoms or changes in the biochemical findings. The clinical outcome, tube independence rate, and patency rate following drainage tube removal were retrospectively evaluated. Except for 2 patients who had failed negotiation of biliary strictures, clinical success was achieved in all 81 patients following percutaneous transhepatic treatment, and the drainage tubes were removed from 76 (93.8%) of these 81 patients. Tubes were removed 11.2 Ϯ 7.4 months after initial percutaneous transhepatic biliary drainage. The recurrence rate at a mean of 36.0 Ϯ 26.2 months following drainage tube removal was 15.8%. One-and three-year primary patency rates were 95.3% Ϯ 2.7% and 80.9% Ϯ 5.2%, respectively. In conclusion, percutaneous transhepatic treatment is an effective alternative treatment for HJ strictures following living donor liver transplantation. However, further research will be required in order to minimize the duration of treatment and the stricture recurrence rate following tube removal.

Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy

“…[5][6][7] In cases of hepaticojejunostomy (HJ), a gastric access loop can be constructed at the time of surgery in the event that future access would be required. 8 In cases of Roux-en-Y gastric bypass (RYGB), endoscopic or laparoscopic gastrostomy placement with subsequent stoma dilation for transgastric ERCP 9 or laparoscopic transgastric ERCP is also possible.…”

Percutaneously placed covered retrievable stents for the treatment of biliary anastomotic strictures following living donor liver transplantation

“…3,4,8,[13][14][15][16] In comparison, the treatment duration in our study was shorter than that for endoscopic plastic stent placement (269-500 days) or for percutaneous transhepatic management (11.2 6 7.4 months). 4,8,13 Therefore, we assume that covered retrievable stents have several advantages. First, the duration of treatment can be reduced because of the larger diameter of the fully covered retrievable stents (8-10 mm) compared to that of plastic stents (5-12 Fr) or indwelling drainage catheters .…”

“…8 Following PTBD, the size of the original drainage catheter in each patient was gradually increased at 4 to 6 week intervals until a 14-French (14-Fr) catheter was finally placed. After maintaining the 14-Fr internal drainage catheter for at least 12 weeks, the catheter was then repositioned above the stricture, and the hub was clamped for at least 4 weeks while the presence of possible elastic recoil at the site of the treated strictures was assessed.…”

“…[1][2][3][4] However, in patients who have previously undergone hepaticojejunal biliary anastomosis or who have failed endoscopic treatment, percutaneous transhepatic management, including percutaneous transhepatic biliary drainage (PTBD) and subsequent balloon dilation or indwelling catheter placement, have also been considered as valuable methods for treating biliary anastomotic strictures. [5][6][7][8] In addition, several investigators have reported that percutaneous transhepatic Abbreviations: Ant., anterior duct; Cx., complication; CBD, common bile duct; DD, duct-to-duct anastomosis; ERBD, endoscopic retrograde biliary drainage; F, female; Fr, French gauge; F/U, follow-up; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HJ, hepaticojejunal anastomosis; int./ext., internal and external; LC, liver cirrhosis; LDLT, living donor liver transplantation; LFT, liver function test; Lt.,left duct; M, male; N/A, not available; No., number of patients; Post., posterior duct; PTBD, percutaneous transhepatic biliary drainage; SD, standard deviation. placement of covered retrievable stents is feasible for treating biliary strictures following liver transplantation.…”

Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review

“…In such cases, percutaneous treatment with balloon dilation with or without long-term biliary drainage and bare or covered stent placement, have been suggested as possible alternatives [2, 4–8]. …”