Successful endoscopic treatment of biliary cast syndrome in an orthotopic liver transplant patient with a Roux-en-Y anastomosis via balloon enteroscopy

Saleem, Atif; Baron, Todd H.

doi:10.1002/lt.22007

Cited by 9 publications

(11 citation statements)

References 6 publications

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“…Endoscopic therapy with ERCP is the primary approach for the management of biliary complications after LT, with PTC reserved for ERCP failures and disconnected ducts that cannot be traversed by a retrograde approach . Recent developments in deep enteroscopy techniques have led to successful endoscopic treatment in many patients with Roux‐en‐Y hepaticojejunostomy, with PTC reserved for the salvage of failures or rendezvous access in combination with ERCP. The spectrum of therapies employed at the time of ERCP includes biliary sphincterotomy, balloon dilation of the sphincter, balloon dilation of strictures, basket and balloon extraction of stones, sludge, and casts (Fig.…”

Section: Treatment Of Biliary Tract Complicationsmentioning

confidence: 99%

Advances in endoscopic management of biliary tract complications after liver transplantation

2013

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Biliary tract complications after liver transplantation (LT) most commonly include biliary leaks, strictures, and stone disease. Living donor recipients and donation after cardiac death recipients are at an increased risk of developing biliary complications. Biliary leaks usually occur early after transplantation, whereas strictures and stone disease occur later. The diagnosis of biliary complications relies on a combination of clinical presentation, laboratory abnormalities, and imaging modalities. Biliary leaks are usually diagnosed on the basis of bilious output from a surgical drain, fluid collections on imaging, or a cholescintigraphy scan demonstrating a leak. Magnetic resonance cholangiopancreatography (MRCP) is noninvasive, does not require the administration of an intravenous contrast agent, and provides detailed imaging of the entire biliary system both above and below the anastomosis. The latter not only helps in the diagnosis of biliary strictures and stones before patients undergo invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) but also allows treating physicians to plan the optimal treatment approach. MRCP has, therefore, replaced invasive therapeutic modalities such as ERCP as the modality of choice for the diagnosis of biliary strictures and stones. There have been significant advances in endoscopic accessories, including biliary catheters, wires, and stents, as well as endoscopic technologies such as overtube-assisted endoscopy over the last decade. These developments have resulted in almost all patients, including those with difficult strictures or altered surgical anatomies (eg, Roux-en-Y hepaticojejunostomy), being treated via an endoscopic approach with percutaneous transhepatic cholangiography, which is more invasive and associated with significant morbidity, with surgery being reserved for a small minority of patients. Advances in the diagnosis and endoscopic management of patients with biliary complications after LT are discussed in this review.

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Section: Treatment Of Biliary Tract Complicationsmentioning

confidence: 99%

Advances in endoscopic management of biliary tract complications after liver transplantation

2013

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“…One study described six types for this syndrome [1]. Most of the previously reported cases of BCS were described in orthotopic liver transplantation [1, 2, 3, 4]. …”

Section: Discussionmentioning

confidence: 99%

“…Retained lithogenic material in the bile duct may lead to obstruction of the biliary tract and also to cholangitis [1, 2]. BCS is an uncommon complication which is mostly described in orthotopic liver transplantation [1, 2, 3, 4]. Biliary complications were reported in 6–34% of all liver transplant patients [5].…”

Section: Introductionmentioning

confidence: 99%

Biliary Cast Syndrome in an Opium Inhaler

Dabiri

Aghdae

Rajabalinia

et al. 2013

Case Rep Gastroenterol

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Biliary cast syndrome (BCS) is an uncommon complication which is mostly described in orthotopic liver transplantation. However, BCS has also been reported rarely in non-liver transplant patients. We describe a male long-term opium inhaler with BCS who underwent successful endoscopic cast removal by balloon enteroscopy-guided endoscopic retrograde cholangiopancreatography. A 52-year-old man, who was a known case of opium addiction, presented with the chief complaint of epigastric pain for 1 week prior to admission. Routine laboratory evaluation revealed cholestatic liver enzyme elevation. A cholestatic pattern was seen in radiographic modalities. Endoscopic retrograde cholangiopancreatography showed a linear filling defect in the intra- and extrahepatic duct. A long biliary cast was successfully removed using an extractor balloon. After removal of the biliary cast the patient is receiving ursodeoxycholic acid and does not report any problem 4 months after treatment. It seems that biliary dyskinesia due to long-term opium use can be a predisposing factor for biliary cast formation.

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“…A single study using this approach achieved biliary intervention successfully in all patients as compared to 58% success rate with deep enteroscopy, and should be evaluated further [90] . Lastly, an alternative approach that may be potentially used in patients with altered anatomy is the use of direct ERC in patients with Roux-en-Y anastomosis to remove biliary stones or casts [83] .…”

Section: Management Of Biliary Complications In Patients With Roux-enmentioning

confidence: 99%

Endoscopic management of post-liver transplant biliary complications

Girotra¹,

Soota²,

Klair³

et al. 2015

WJGE

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Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques that have proved endoscopic retrograde cholangiography with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also discuss the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality. Core tip: Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques which have proved ERCP with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also deliberate the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality.

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Successful endoscopic treatment of biliary cast syndrome in an orthotopic liver transplant patient with a Roux-en-Y anastomosis via balloon enteroscopy

Cited by 9 publications

References 6 publications

Advances in endoscopic management of biliary tract complications after liver transplantation

Advances in endoscopic management of biliary tract complications after liver transplantation

Biliary Cast Syndrome in an Opium Inhaler

Endoscopic management of post-liver transplant biliary complications

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