Post-liver transplant biliary complications: Current knowledge and therapeutic advances

Boeva, Irina; Karagyozov, Petko; Tishkov, Ivan

doi:10.4254/wjh.v13.i1.66

Cited by 57 publications

(72 citation statements)

References 87 publications

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“…Biliary strictures affect up to nearly 40% of post-OLT patients[ 54 ]. In these cases, POC can be utilized for visual assessment of the biliary epithelium and/or targeted biopsy, if needed[ 55 ]. Additionally, some strictures are not amenable to guidewire insertion or cannulation with standard ERCP ( e.g.…”

Section: Common Applications Of Cholangioscopymentioning

confidence: 99%

Peroral cholangioscopy: Update on the state-of-the-art

Subhash¹,

Buxbaum²,

Tabibian³

2022

WJGE

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Peroral cholangioscopy (POC) is an endoscopic procedure that allows direct intraductal visualization of the biliary tract. POC has emerged as a vital tool for indeterminate biliary stricture evaluation and treatment of difficult biliary stones. Over several generations of devices, POC has fulfilled additional clinical needs where other diagnostic or therapeutic modalities have been inadequate. With adverse event rates comparable to standard endoscopic retrograde cholangioscopy and unique technical attributes, the role of POC is likely to continue expand. In this frontiers article, we highlight the existing and growing clinical applications of POC as well as areas of ongoing research.

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Section: Common Applications Of Cholangioscopymentioning

confidence: 99%

Peroral cholangioscopy: Update on the state-of-the-art

Subhash¹,

Buxbaum²,

Tabibian³

2022

WJGE

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“…CBD stones after liver transplantation have an incidence between 4% and 10% of cases[ 99 ]. Biliary strictures are the major predisposing risk factor for biliary CBD stones, occurring in up to 90% of liver transplant patients with biliary stones[ 100 ].…”

Section: Different Approaches For Patients With Altered Anatomymentioning

confidence: 99%

“…Biliary stones in post-liver transplantation patients may cause severe complications such as pancreatitis, biliary infections and biliary cirrhosis, which can drastically worsen the graft’s course. The endoscopic management of CBD stones in this setting of patients is successful in over 90% of cases, although the presence of anastomotic strictures results in a challenging and demanding procedure and increases the difficulty of stones removal[ 99 ]. In this context the strictures have to be treated simultaneously with stone extraction, using balloon dilation and mechanical lithotripsy and reserving the use of cholangioscopy-assisted lithotripsy in case of failure[ 102 ].…”

Section: Different Approaches For Patients With Altered Anatomymentioning

confidence: 99%

Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review

Tringali¹,

Costa²,

Fugazza³

et al. 2021

WJG

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Endoscopic management for difficult common bile duct (CBD) stones still presents a challenge for several reasons, including anatomic anomalies, patients’ individual conditions and stone features. In recent years, variable methods have emerged that have attributed to higher stone removal success rates, reduced cost and lower adverse events. In this review, we outline a stepwise approach in CBD stone management. As first line therapy, endoscopic sphincterotomy and large balloon dilation are recommended, due to a 30%-50% reduction of the use of mechanical lithotripsy. On the other hand, cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence. As discussed, findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions. Furthermore, we evaluate the management of CBD stones in various surgical altered anatomy (Billroth II, Roux-en-Y and Roux-en-Y gastric bypass). Moreover, we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use, rather than following a failed management option. In addition, we discuss the importance of dissecting other techniques, such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed. In conclusion, we recognize that endoscopic sphincterotomy and large balloon dilation, mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones, but emerging techniques are in rapid evolution with encouraging results.

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“…Iatrogenic bile duct injuries, for example, represent a serious surgical complication of laparoscopic cholecystectomy (Limaylla-Vega & Vega-Gonzales, 2017). Anatomical knowledge, proper identification and drainage of all ducts are relevant and fundamental in order to avoid future errors (Cohen et al;Boeva et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Morphometric Study of Extra-Hepatic Biliary Pathways - Study in Human Corpses

et al. 2022

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Adverse events (AE) contribute significantly to postoperative morbidities and co-morbidities. Many AEs occur due to a lack of anatomical knowledge and its variants. Latrogenic bile duct injuries, for instance, represent a serious surgical complication of laparoscopic cholecystectomy. Anatomical knowledge for the identification and adequate drainage of all ducts is relevant and fundamental in order to avoid future errors. The objective of the study was to morphometrically analyze the bile ducts in adult human corpses. 13 livers were extracted from adult human corpses to obtain the ducts: choledochal, common hepatic and cystic. After morphological analysis, duct measurements (length and diameter) were continued using a digital caliper. The data obtained were tabulated in SPSS 21 program, performing descriptive analysis with mean and standard deviation. The averages of bile ducts were 61.05 (± 16.43) mm in length and 3.86 (± 0.72) mm in diameter. The cystic duct length and diameter averages were 33.59 (± 12.29) mm and 3.40 (± 0.79) mm, respectively. The common hepatic ducts had an average of 30.02 (± 7.19) mm in length and 3.74 (± 1.18) mm in diameter. The analyzedsamples presented different values ??from those already described in the literature, where the length of the cystic ducts was greater, while the length of the common hepatic ducts was numerically smaller. This work is very significant, as the morphometric variability of the bile ducts allows for varying morphological situations that can compromise the hepatobiliar physiology.

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Post-liver transplant biliary complications: Current knowledge and therapeutic advances

Cited by 57 publications

References 87 publications

Peroral cholangioscopy: Update on the state-of-the-art

Peroral cholangioscopy: Update on the state-of-the-art

Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review

Morphometric Study of Extra-Hepatic Biliary Pathways - Study in Human Corpses

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