Endoscopic Treatment of Biliary Tract Complications after Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIAO Juan , LI Rongkun , WANG Chunhui , HU Bing , TANG Chengwei.

Department of Gastrointestinal Endoscopic Center, West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: HU Bing, E-mail: microsurgeon@gmail.com;

Corresponding author：

Keywords：

Liver transplantation; Biliary tract complication; Endoscopic treatment

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Objective 　To evaluate the therapeutic effects of endoscopic treatment on biliary tract complications after liver transplantation.
Methods　 The clinical data of 55 patients with biliary tract complications after liver transplantation undergoing endoscopic treatment from January 2006 to June 2009 were analyzed retrospectively.
Results 　Ninety-eight times of endoscopic treatment were performed in 55 patients. There were 11 cases of biliary fistula, 4 cases of bile duct stricture with biliary fistula, 21 cases of bile duct stricture, 12 cases of bile duct stricture with biliary sludge or stones, 3 cases of biliary sludge or stones, 2 cases of angular distortion of the bile duct and papilla duodeni stenosis in 2 cases. Different procedures including biliary tract dilation, endoscopic nasobiliary drainage, endoscopic sphincterotomy, stone extraction technique and biliary stent placement were performed in different biliary tract complications. The endoscopic treatments were successful in 46 cases (83.6%). The procedure related complications were found in 13 times (13.3%).
Conclusion 　Endoscopy may serve as the primary modality for treating biliary tract complications after liver transplantation with safety and effectiveness.

Citation： LIAO Juan,LI Rongkun,WANG Chunhui,HU Bing,TANG Chengwei.. Endoscopic Treatment of Biliary Tract Complications after Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(4): 333-337. doi: Copy

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2.	Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl, 2001; 7(11 Suppl 1): S46-S52.
3.	Patkowski W, Nyckowski P, Zieniewicz K, et al. Biliary tract complications following liver transplantation [J]. Transplant Proc, 2003; 35(6): 2316-2317.
4.	Yuan D, Wei YG, Lin HM, et al. Risk factors of biliary complications following liver transplantation: retrospective analysis of a single centre [J]. Postgrad Med J, 2009; 85(1001): 119-123.
5.	汪根树, 陈规划, 陆敏强, 等. 原位肝移植术后胆管狭窄的治疗(附43例报告) [J]. 中国实用外科杂志, 2006; 26(6): 432-433.
6.	Egawa H, Inomata Y, Uemoto S, et al. Biliary anastomotic complications in 400 living related liver transplantations [J]. World J Surg, 2001; 25(10): 1300-1307.
7.	Halme L, Hockerstedt K, Lautenschlager I. Cytomegalovirus infection and development of biliary complications after liver transplantation [J]. Transplantation, 2003; 75(11): 1853-1858.
8.	Shah SR, Dooley J, Agarwal R, et al. Routine endoscopic retrograde cholangiography in the detection of early biliary complications after liver transplantation [J]. Liver Transpl, 2002; 8(5): 491-494.
9.	Park JS, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003; 57(1): 78-85.
10.	Cescon M, Grazi GL, Ravaioli M, et al. Conventional split liver transplantation for two adult recipients: a recent experience in a single European center [J]. Transplantation, 2009; 88(9): 1117-1122.
11.	冉江华, 张升宁, 李铸, 等. 肝动脉-腹主动脉搭桥在原位肝移植术中的应用 [J]. 中国普外基础与临床杂志, 2008; 15(2): 102-105.
12.	陈刚, 朱锋, 刘其雨, 等. 存在大血管侵犯的肝癌患者的肝移植(附8例报道) [J]. 中国普外基础与临床杂志, 2008; 15(7): 484-486.
13.	Wojcicki M, Lubikowski J, Klek R, et al. Reduction of biliary complication rate using continuous suture and no biliary drainage for duct-to-duct anastomosis in whole-organ liver transplantation [J]. Transplant Proc, 2009; 41(8): 3126-3130.
14.	Saidi RF, Elias N, Ko DS, et al. Biliary reconstruction and complications after living-donor liver transplantation [J]. HPB (Oxford), 2009; 11(6): 505-509.
15.	朱新锋, 陈刚, 张文夺, 等. 肝移植术后应用胸腺肽α1对急性排斥反应的影响 [J]. 中国普外基础与临床杂志, 2008; 15(6): 430-434.
16.	Kyoden Y, Tamura S, Sugawara Y, et al. Incidence and management of biliary complications after adult-to-adult living donor liver transplantation [J]. Clin Transplant, 2009 Oct 22 [Epub ahead of print].
17.	Rerknimitr R, Sherman S, Fogel EL, et al. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy [J]. Gastrointest Endosc, 2002; 55(2): 224-231.
18.	Solmi L, Cariani G, Leo P, et al. Results of endoscopic retrograde cholangiopancreatography in the treatment of biliary tract complications after orthotopic liver transplantation: our experience [J]. Hepatogastroenterology, 2007; 54(76): 1004-1008.
19.	Icoz G, Kilic M, Zeytunlu M, et al. Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations [J]. Liver Transpl, 2003; 9(6): 575-580.
20.	Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy [J]. Gastrointest Endosc, 2007; 66(1): 44-51.
21.	Elmi F, Silverman WB. Outcome of ERCP in the management of duct-to-duct anastomotic strictures in orthotopic liver transplant [J]. Dig Dis Sci, 2007; 52(9): 2346-2350.
22.	Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation [J]. Endoscopy, 2000; 32(12): 943-949.
23.	Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation [J]. Liver Int, 2003; 23(3): 156-162.
24.	Scanga AE, Kowdley KV. Management of biliary complications following orthotopic liver transplantation [J]. Curr Gastroenterol Rep, 2007; 9(1): 31-38.
25.	Spier BJ, Pfau PR, Lorenze KR, et al. Risk factors and outcomes in post-liver transplantation bile duct stones and casts: A case-control study [J]. Liver Transpl, 2008; 14(10): 1461-1465.

1. Thethy S, Thomson BNj, Pleass H, et al. Management of biliary tract complications after orthotopic liver transplantation [J]. Clin Transplant, 2004; 18(6): 647-653.
2. 　Moser MA, Wall WJ. Management of biliary problems after liver transplantation [J]. Liver Transpl, 2001; 7(11 Suppl 1): S46-S52.
3. 　Patkowski W, Nyckowski P, Zieniewicz K, et al. Biliary tract complications following liver transplantation [J]. Transplant Proc, 2003; 35(6): 2316-2317.
4. 　Yuan D, Wei YG, Lin HM, et al. Risk factors of biliary complications following liver transplantation: retrospective analysis of a single centre [J]. Postgrad Med J, 2009; 85(1001): 119-123.
5. 　汪根树, 陈规划, 陆敏强, 等. 原位肝移植术后胆管狭窄的治疗(附43例报告) [J]. 中国实用外科杂志, 2006; 26(6): 432-433.
6. 　Egawa H, Inomata Y, Uemoto S, et al. Biliary anastomotic complications in 400 living related liver transplantations [J]. World J Surg, 2001; 25(10): 1300-1307.
7. 　Halme L, Hockerstedt K, Lautenschlager I. Cytomegalovirus infection and development of biliary complications after liver transplantation [J]. Transplantation, 2003; 75(11): 1853-1858.
8. 　Shah SR, Dooley J, Agarwal R, et al. Routine endoscopic retrograde cholangiography in the detection of early biliary complications after liver transplantation [J]. Liver Transpl, 2002; 8(5): 491-494.
9. 　Park JS, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation [J]. Gastrointest Endosc, 2003; 57(1): 78-85.
10. 　Cescon M, Grazi GL, Ravaioli M, et al. Conventional split liver transplantation for two adult recipients: a recent experience in a single European center [J]. Transplantation, 2009; 88(9): 1117-1122.
11. 　冉江华, 张升宁, 李铸, 等. 肝动脉-腹主动脉搭桥在原位肝移植术中的应用 [J]. 中国普外基础与临床杂志, 2008; 15(2): 102-105.
12. 　陈刚, 朱锋, 刘其雨, 等. 存在大血管侵犯的肝癌患者的肝移植(附8例报道) [J]. 中国普外基础与临床杂志, 2008; 15(7): 484-486.
13. 　Wojcicki M, Lubikowski J, Klek R, et al. Reduction of biliary complication rate using continuous suture and no biliary drainage for duct-to-duct anastomosis in whole-organ liver transplantation [J]. Transplant Proc, 2009; 41(8): 3126-3130.
14. 　Saidi RF, Elias N, Ko DS, et al. Biliary reconstruction and complications after living-donor liver transplantation [J]. HPB (Oxford), 2009; 11(6): 505-509.
15. 　朱新锋, 陈刚, 张文夺, 等. 肝移植术后应用胸腺肽α1对急性排斥反应的影响 [J]. 中国普外基础与临床杂志, 2008; 15(6): 430-434.
16. 　Kyoden Y, Tamura S, Sugawara Y, et al. Incidence and management of biliary complications after adult-to-adult living donor liver transplantation [J]. Clin Transplant, 2009 Oct 22 [Epub ahead of print].
17. 　Rerknimitr R, Sherman S, Fogel EL, et al. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy [J]. Gastrointest Endosc, 2002; 55(2): 224-231.
18. 　Solmi L, Cariani G, Leo P, et al. Results of endoscopic retrograde cholangiopancreatography in the treatment of biliary tract complications after orthotopic liver transplantation: our experience [J]. Hepatogastroenterology, 2007; 54(76): 1004-1008.
19. 　Icoz G, Kilic M, Zeytunlu M, et al. Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations [J]. Liver Transpl, 2003; 9(6): 575-580.
20. 　Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy [J]. Gastrointest Endosc, 2007; 66(1): 44-51.
21. 　Elmi F, Silverman WB. Outcome of ERCP in the management of duct-to-duct anastomotic strictures in orthotopic liver transplant [J]. Dig Dis Sci, 2007; 52(9): 2346-2350.
22. 　Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation [J]. Endoscopy, 2000; 32(12): 943-949.
23. 　Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation [J]. Liver Int, 2003; 23(3): 156-162.
24. 　Scanga AE, Kowdley KV. Management of biliary complications following orthotopic liver transplantation [J]. Curr Gastroenterol Rep, 2007; 9(1): 31-38.
25. 　Spier BJ, Pfau PR, Lorenze KR, et al. Risk factors and outcomes in post-liver transplantation bile duct stones and casts: A case-control study [J]. Liver Transpl, 2008; 14(10): 1461-1465.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Endoscopic Treatment of Biliary Tract Complications after Liver Transplantation

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