Intraductal Electrocautery Incision of Anastomotic Biliary Strictures after Liver Transplantation Using Wire-Guided Sphincterotomes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PANG Yong , ZHANG Bingyin , TIAN Fuzhou , BAI Wentao , LIU Danqing , HUANG Shangqin , GAO Qian

Department of Minimally Invasive Surgery， General Surgery Center of PLA， Chengdu Military General Hospital，Chengdu 610083， Sichuan Province， China;

Corresponding author：

Keywords：

Liver transplantation; Anastomotic stricture; Bile duct diseases; Endoscopic retrograde cholangiopancreatography

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Objective 　To investigate whether intraductal electrocautery incision （IEI） could decrease the recurrence of post-liver transplant anastomotic strictures （PTAS） after conventional endoscopic intervention of balloon dilatation （BD） and plastic stenting （PS）.
Methods 　The clinical data of 27 patients with PTAS who were given endoscopic treatment of BD＋PS or IEI＋BD＋PS in our hospital from January 2007 to October 2011 were reviewed retrospectively.
Results 　The treatment of BD＋PS was initially successful in 9 of 11 （81.8%） cases， but showed recurrence in 5 of 9 （55.6%）. The treatment of IEI＋BD＋PS was initially successful in 14 of 16 （87.5%） cases, and the recurrence was observed only in 3 of 14 （21.4%）. The total diameter of inserted plastic stents in IEI＋BD＋PS group was significantly greater than that in BD＋PS group 〔（12±3.2） Fr vs. （8±1.3） Fr，P=0.039〕. All recurrences were successfully retreated by IEI＋BD＋PS. Procedure-related complications included pancreatitis in 5 cases （18.5%）, cholangitis in 8 cases （29.6%）, bleeding after EST in 1 cases （3.7%）, which were all cured with medical treatment. No complications related to intraductal endocautery incision procedure such as bleeding and perforation were observed. Median follow-up after completion of endoscopic therapy was 22 months （range 1-49 months）.
Conclusions 　Intraductal electrocautery incision is an effective and safe supplement to balloon dilatation and plastic stenting treatment of PTAS, which can decrease the recurrence of anastomotic strictures in conventional endoscopic intervention.

Citation： PANG Yong,ZHANG Bingyin,TIAN Fuzhou,BAI Wentao,LIU Danqing,HUANG Shangqin,GAO Qian,.. Intraductal Electrocautery Incision of Anastomotic Biliary Strictures after Liver Transplantation Using Wire-Guided Sphincterotomes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(4): 377-381. doi: Copy

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2.	Seo JK， Ryu JK， Lee SH， et al. Endoscopic treatment for biliary stricture after adult living donor liver transplantation [J]. Liver Transpl， 2009， 15(4)： 369-380.
3.	Koneru B， Sterling MJ， Bahramipour PF. Bile duct strictures after liver transplantation： a changing landscape of the Achilles’heel [J]. Liver Transpl， 2006， 12(5)： 702-704.
4.	Williams ED， Draganov PV. Endoscopic management of biliary strictures after liver transplantation [J]. World J Gastroenterol，2009， 15(30)： 3725-3733.
5.	Gondolesi GE， Varotti G， Florman SS， et al. Biliary complications in 96 consecutive right lobe living donor transplant recipients [J]. Transplantation， 2004， 77(12)： 1842-1848.
6.	Graziadei IW， Schwaighofer H， Koch R， et al. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation[J]. Liver Transpl， 2006， 12(5)： 718-725.
7.	Hisatsune H， Yazumi S， Egawa H， et al. Endoscopic management of biliary strictures after duct-to-duct biliary Reconstruction in right-lobe living-donor liver transplantation [J]. Transplantation，2003， 76(5)： 810-815.
8.	Takatsuki M， Eguchi S， Kawashita Y， et al. Biliary complications in recipients of living-donor liver transplantation [J]. J Hepatobiliary Pancreat Surg， 2006， 13(6)： 497-501.
9.	Todo S， Furukawa H， Kamiyama T. How to prevent and manage biliary complications in living donor liver transplantation? [J]. J Hepatol， 2005， 43(1)： 22-27.
10.	Zoepf T， Maldonado-Lopez EJ， Hilgard P， et al. Endoscopic therapy of posttransplant biliary stenoses after right-sided adult living donor liver transplantation [J]. Clin Gastroenterol Hepatol，2005， 3(11)： 1144-1149.
11.	Qian YB， Liu CL， Lo CM， et al. Risk factors for biliary complications after liver transplantation [J]. Arch Surg， 2004，139(10)： 1101-1105.
12.	Greif F， Bronsther OL， Van Thiel DH， et al. The incidence，timing， and management of biliary tract complications after orthotopic liver transplantation [J]. Ann Surg， 1994， 219(1)：40-45.
13.	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.
14.	Verdonk RC， Buis CI， Porte RJ， et al. Anastomotic biliary strictures after liver transplantation： causes and consequences [J].Liver Transpl， 2006， 12(5)： 726-735.
15.	Bentabak K， Graba A， Boudjema K， et al. Adult-to-adult living related liver transplantation： preliminary results of the hepatic transplantation group in Algiers [J]. Transplant Proc， 2005，37(6)： 2873-2874.
16.	Alazmi WM， Fogel EL， Watkins JL， et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation [J]. Endoscopy， 2006， 38(6)：571-574.
17.	Sharma S， Gurakar A， Jabbour N. Biliary strictures following liver transplantation： past， present and preventive strategies [J].Liver Transpl， 2008， 14(6)： 759-769.
18.	Chung YH， Lu HI， Lin AS， et al. Bronchoscopic electrocautery for palliation of post-anastomotic tracheal stricture in a patient with complete tracheal transection following blunt chest trauma [J]. Chang Gung Med J， 2005， 28(10)： 724-729.
19.	Hordijk ML， van Hooft JE， Hansen BE， et al. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures [J]. Gastrointest Endosc， 2009， 70(5)： 849-855.
20.	Hordijk ML， Siersema PD， Tilanus HW， et al. Electrocautery therapy for refractory anastomotic strictures of the esophagus [J]. Gastrointest Endosc， 2006， 63(1)： 157-163.
21.	Testa G， Malagò M， Broelseh CE. Complications of biliary tract in liver transplantation [J]. World J Surg， 2001， 25(10)： 1296-1299.
22.	Jagannath S， Kalloo AN. Biliary complications after liver transplantation [J]. Curr Treat Options Gastroenterol， 2002， 5(2)：101-112.
23.	Ostroff JW. Post-transplant biliary problems [J]. Gastrointest Endosc Clin N Am， 2001， 11(1)： 163-183.
24.	Pascher A， Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation [J]. J Hepatobiliary Pancreat Surg， 2006， 13(6)： 487-496.
25.	Akiho H， Sumida Y， Akahoshi K， et al. Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis[J]. World J Gastroenterol， 2006， 12(13)： 2086-2088.

1. Zoepf T， Maldonado-Lopez EJ， Hilgard P， et al. Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation [J]. Liver Transpl， 2006， 12(1)：88-94.
2. Seo JK， Ryu JK， Lee SH， et al. Endoscopic treatment for biliary stricture after adult living donor liver transplantation [J]. Liver Transpl， 2009， 15(4)： 369-380.
3. Koneru B， Sterling MJ， Bahramipour PF. Bile duct strictures after liver transplantation： a changing landscape of the Achilles’heel [J]. Liver Transpl， 2006， 12(5)： 702-704.
4. Williams ED， Draganov PV. Endoscopic management of biliary strictures after liver transplantation [J]. World J Gastroenterol，2009， 15(30)： 3725-3733.
5. Gondolesi GE， Varotti G， Florman SS， et al. Biliary complications in 96 consecutive right lobe living donor transplant recipients [J]. Transplantation， 2004， 77(12)： 1842-1848.
6. Graziadei IW， Schwaighofer H， Koch R， et al. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation[J]. Liver Transpl， 2006， 12(5)： 718-725.
7. Hisatsune H， Yazumi S， Egawa H， et al. Endoscopic management of biliary strictures after duct-to-duct biliary Reconstruction in right-lobe living-donor liver transplantation [J]. Transplantation，2003， 76(5)： 810-815.
8. Takatsuki M， Eguchi S， Kawashita Y， et al. Biliary complications in recipients of living-donor liver transplantation [J]. J Hepatobiliary Pancreat Surg， 2006， 13(6)： 497-501.
9. Todo S， Furukawa H， Kamiyama T. How to prevent and manage biliary complications in living donor liver transplantation? [J]. J Hepatol， 2005， 43(1)： 22-27.
10. Zoepf T， Maldonado-Lopez EJ， Hilgard P， et al. Endoscopic therapy of posttransplant biliary stenoses after right-sided adult living donor liver transplantation [J]. Clin Gastroenterol Hepatol，2005， 3(11)： 1144-1149.
11. Qian YB， Liu CL， Lo CM， et al. Risk factors for biliary complications after liver transplantation [J]. Arch Surg， 2004，139(10)： 1101-1105.
12. Greif F， Bronsther OL， Van Thiel DH， et al. The incidence，timing， and management of biliary tract complications after orthotopic liver transplantation [J]. Ann Surg， 1994， 219(1)：40-45.
13. 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.
14. Verdonk RC， Buis CI， Porte RJ， et al. Anastomotic biliary strictures after liver transplantation： causes and consequences [J].Liver Transpl， 2006， 12(5)： 726-735.
15. Bentabak K， Graba A， Boudjema K， et al. Adult-to-adult living related liver transplantation： preliminary results of the hepatic transplantation group in Algiers [J]. Transplant Proc， 2005，37(6)： 2873-2874.
16. Alazmi WM， Fogel EL， Watkins JL， et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation [J]. Endoscopy， 2006， 38(6)：571-574.
17. Sharma S， Gurakar A， Jabbour N. Biliary strictures following liver transplantation： past， present and preventive strategies [J].Liver Transpl， 2008， 14(6)： 759-769.
18. Chung YH， Lu HI， Lin AS， et al. Bronchoscopic electrocautery for palliation of post-anastomotic tracheal stricture in a patient with complete tracheal transection following blunt chest trauma [J]. Chang Gung Med J， 2005， 28(10)： 724-729.
19. Hordijk ML， van Hooft JE， Hansen BE， et al. A randomized comparison of electrocautery incision with Savary bougienage for relief of anastomotic gastroesophageal strictures [J]. Gastrointest Endosc， 2009， 70(5)： 849-855.
20. Hordijk ML， Siersema PD， Tilanus HW， et al. Electrocautery therapy for refractory anastomotic strictures of the esophagus [J]. Gastrointest Endosc， 2006， 63(1)： 157-163.
21. Testa G， Malagò M， Broelseh CE. Complications of biliary tract in liver transplantation [J]. World J Surg， 2001， 25(10)： 1296-1299.
22. Jagannath S， Kalloo AN. Biliary complications after liver transplantation [J]. Curr Treat Options Gastroenterol， 2002， 5(2)：101-112.
23. Ostroff JW. Post-transplant biliary problems [J]. Gastrointest Endosc Clin N Am， 2001， 11(1)： 163-183.
24. Pascher A， Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation [J]. J Hepatobiliary Pancreat Surg， 2006， 13(6)： 487-496.
25. Akiho H， Sumida Y， Akahoshi K， et al. Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis[J]. World J Gastroenterol， 2006， 12(13)： 2086-2088.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Intraductal Electrocautery Incision of Anastomotic Biliary Strictures after Liver Transplantation Using Wire-Guided Sphincterotomes

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