Peroral cholangioscopy-guided stricture therapy in living donor liver transplantation

Parsi, Mansour A.; Guardino, Jason M.; Vargo, John J.

doi:10.1002/lt.21584

Cited by 28 publications

(22 citation statements)

References 7 publications

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“…Combination use of a bendable ERCP catheter (SwingTip cannula; Olympus EndoTherapy, Tokyo, Japan) and an angle-tip hydrophilic guide wire with high torque control (e.g., Radifocus Guidewire; Terumo, Tokyo, Japan) can assist negotiation of difficult strictures. In LDLT patients with difficult-to-pass strictures by conventional methods, a single-operator peroral cholangioscopy (SpyGlass System; Boston Scientific, Natick, MA, USA) may enable passage of a guide wire through the stricture under direct visualization [55,56]. Woo et al reported that the SpyGlass was helpful in passage of a guide wire in 9 (60%) of 15 LDLT patients with unsuccessful conventional methods [56].…”

Section: Endoscopic Management Of Biliary Strictures After Ldltmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Section: Endoscopic Management Of Biliary Strictures After Ldltmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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“…Its other advantages are a 4-way tip deflection, which allows better access and maneuverability, and 2 dedicated irrigation channels allowing better visualization of intraductal pathology. I and my colleagues have previously reported our experience with this system in the treatment of difficult to remove biliary stones [13] , evaluation of indeterminate biliary strictures [14] , investigation of "idiopathic" recurrent acute pancreatitis [15] and treatment of anastomotic strictures in liver transplant patients [16] . This study reports the experience of using this device for removal of impacted stones in the cystic duct remnant.…”

Section: Discussionmentioning

confidence: 99%

Peroral cholangioscopy-assisted guidewire placement for removal of impacted stones in the cystic duct remnant

Parsi¹

2009

WJGS

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It is well known that impacted biliary stones are difficult to remove endoscopically. Among the many factors associated with failure of endoscopic therapy for removal of bile duct stones, impaction ranks high. One of the reasons behind failure of endoscopic therapy in such cases is that the impacted stone often does not allow passage of a guidewire. Recent introduction of a novel single-operator cholangioscopy system has made it possible for a single endoscopist to use cholangioscopy for evaluation and treatment of a wide variety of biliary disorders. This cholangioscopy system was used for placement of a guidewire in the cystic duct remnant with subsequent removal of an impacted stone which had prevented passage of a guidewire by conventional means.

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“…Newer techniques like cholangioscopy (spyglass) have been described in LDLT for traversing difficult strictures [50,51] . However in our limited experience of three cases, we did not find it of any additional benefit.…”

Section: Technical Challengesmentioning

confidence: 99%

Management issues in post living donor liver transplant biliary strictures

Wadhawan¹,

Kumar²

2016

WJH

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Peroral cholangioscopy-guided stricture therapy in living donor liver transplantation

Cited by 28 publications

References 7 publications

Endoscopic management of biliary strictures after living donor liver transplantation

Endoscopic management of biliary strictures after living donor liver transplantation

Peroral cholangioscopy-assisted guidewire placement for removal of impacted stones in the cystic duct remnant

Management issues in post living donor liver transplant biliary strictures

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