Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation

Sung Ill Jang, Jie Hyun Kim, Jong Yoon Won, Kwang Hoon Lee, Hee Wook Kim, Jung Whan You, Takao Itoi, Dongki Lee

Research output: Contribution to journalArticle

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Abstract

Background: An anastomotic biliary stricture is a complication of living donor liver transplantation (LDLT) performed using duct-to-duct anastomosis. Despite advances in treating this complication, there is no one established treatment protocol. Objective: To investigate the safety, effectiveness, and mid-term outcome of magnetic compression anastomosis (MCA) for treating biliary obstruction after LDLT when the obstruction cannot be resolved by using percutaneous or peroral methods. Design: Retrospective, observational study with standardized treatment and follow-up. Setting: Tertiary-care academic medical center. Patients: Twelve patients underwent MCA procedures to treat anastomosis site stricture after LDLT. Interventions: MCA. Main Outcome Measurements: Bile duct patency, technique performance, and complications were evaluated. Results: We achieved magnet approximation at the anastomotic stricture in 10 of 12 patients (83.3%). The magnets failed to approximate in 2 patients. We achieved recanalization of the stricture site in 10 of 10 patients. We removed an internal catheter in 9 patients. The mean interval from magnet approximation to removal was 74.2 days (range 14-181 days). The mean time from recanalization to removal of the internal catheter was 183 days (range 51-266 days). Patients were examined regularly after removing the internal catheter with a mean follow-up period of 331 days (range 148-581 days). The observed MCA-related complications consisted of 1 case of mild cholangitis and 1 recurrence of the anastomotic stricture. Limitations: Nonrandomized study design. Conclusions: MCA safely and effectively resolved post-LDLT biliary duct-to-duct anastomotic strictures that could not be resolved using conventional methods, such as ERCP and percutaneous transhepatic biliary drainage.

Original languageEnglish
Pages (from-to)1040-1048
Number of pages9
JournalGastrointestinal Endoscopy
Volume74
Issue number5
DOIs
Publication statusPublished - 2011 Nov 1

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Living Donors
Liver Transplantation
Pathologic Constriction
Magnets
Catheters
Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Tertiary Healthcare
Clinical Protocols
Bile Ducts
Observational Studies
Drainage
Retrospective Studies
Safety
Recurrence

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Jang, Sung Ill ; Kim, Jie Hyun ; Won, Jong Yoon ; Lee, Kwang Hoon ; Kim, Hee Wook ; You, Jung Whan ; Itoi, Takao ; Lee, Dongki. / Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation. In: Gastrointestinal Endoscopy. 2011 ; Vol. 74, No. 5. pp. 1040-1048.
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abstract = "Background: An anastomotic biliary stricture is a complication of living donor liver transplantation (LDLT) performed using duct-to-duct anastomosis. Despite advances in treating this complication, there is no one established treatment protocol. Objective: To investigate the safety, effectiveness, and mid-term outcome of magnetic compression anastomosis (MCA) for treating biliary obstruction after LDLT when the obstruction cannot be resolved by using percutaneous or peroral methods. Design: Retrospective, observational study with standardized treatment and follow-up. Setting: Tertiary-care academic medical center. Patients: Twelve patients underwent MCA procedures to treat anastomosis site stricture after LDLT. Interventions: MCA. Main Outcome Measurements: Bile duct patency, technique performance, and complications were evaluated. Results: We achieved magnet approximation at the anastomotic stricture in 10 of 12 patients (83.3{\%}). The magnets failed to approximate in 2 patients. We achieved recanalization of the stricture site in 10 of 10 patients. We removed an internal catheter in 9 patients. The mean interval from magnet approximation to removal was 74.2 days (range 14-181 days). The mean time from recanalization to removal of the internal catheter was 183 days (range 51-266 days). Patients were examined regularly after removing the internal catheter with a mean follow-up period of 331 days (range 148-581 days). The observed MCA-related complications consisted of 1 case of mild cholangitis and 1 recurrence of the anastomotic stricture. Limitations: Nonrandomized study design. Conclusions: MCA safely and effectively resolved post-LDLT biliary duct-to-duct anastomotic strictures that could not be resolved using conventional methods, such as ERCP and percutaneous transhepatic biliary drainage.",
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Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation. / Jang, Sung Ill; Kim, Jie Hyun; Won, Jong Yoon; Lee, Kwang Hoon; Kim, Hee Wook; You, Jung Whan; Itoi, Takao; Lee, Dongki.

In: Gastrointestinal Endoscopy, Vol. 74, No. 5, 01.11.2011, p. 1040-1048.

Research output: Contribution to journalArticle

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AU - Jang, Sung Ill

AU - Kim, Jie Hyun

AU - Won, Jong Yoon

AU - Lee, Kwang Hoon

AU - Kim, Hee Wook

AU - You, Jung Whan

AU - Itoi, Takao

AU - Lee, Dongki

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N2 - Background: An anastomotic biliary stricture is a complication of living donor liver transplantation (LDLT) performed using duct-to-duct anastomosis. Despite advances in treating this complication, there is no one established treatment protocol. Objective: To investigate the safety, effectiveness, and mid-term outcome of magnetic compression anastomosis (MCA) for treating biliary obstruction after LDLT when the obstruction cannot be resolved by using percutaneous or peroral methods. Design: Retrospective, observational study with standardized treatment and follow-up. Setting: Tertiary-care academic medical center. Patients: Twelve patients underwent MCA procedures to treat anastomosis site stricture after LDLT. Interventions: MCA. Main Outcome Measurements: Bile duct patency, technique performance, and complications were evaluated. Results: We achieved magnet approximation at the anastomotic stricture in 10 of 12 patients (83.3%). The magnets failed to approximate in 2 patients. We achieved recanalization of the stricture site in 10 of 10 patients. We removed an internal catheter in 9 patients. The mean interval from magnet approximation to removal was 74.2 days (range 14-181 days). The mean time from recanalization to removal of the internal catheter was 183 days (range 51-266 days). Patients were examined regularly after removing the internal catheter with a mean follow-up period of 331 days (range 148-581 days). The observed MCA-related complications consisted of 1 case of mild cholangitis and 1 recurrence of the anastomotic stricture. Limitations: Nonrandomized study design. Conclusions: MCA safely and effectively resolved post-LDLT biliary duct-to-duct anastomotic strictures that could not be resolved using conventional methods, such as ERCP and percutaneous transhepatic biliary drainage.

AB - Background: An anastomotic biliary stricture is a complication of living donor liver transplantation (LDLT) performed using duct-to-duct anastomosis. Despite advances in treating this complication, there is no one established treatment protocol. Objective: To investigate the safety, effectiveness, and mid-term outcome of magnetic compression anastomosis (MCA) for treating biliary obstruction after LDLT when the obstruction cannot be resolved by using percutaneous or peroral methods. Design: Retrospective, observational study with standardized treatment and follow-up. Setting: Tertiary-care academic medical center. Patients: Twelve patients underwent MCA procedures to treat anastomosis site stricture after LDLT. Interventions: MCA. Main Outcome Measurements: Bile duct patency, technique performance, and complications were evaluated. Results: We achieved magnet approximation at the anastomotic stricture in 10 of 12 patients (83.3%). The magnets failed to approximate in 2 patients. We achieved recanalization of the stricture site in 10 of 10 patients. We removed an internal catheter in 9 patients. The mean interval from magnet approximation to removal was 74.2 days (range 14-181 days). The mean time from recanalization to removal of the internal catheter was 183 days (range 51-266 days). Patients were examined regularly after removing the internal catheter with a mean follow-up period of 331 days (range 148-581 days). The observed MCA-related complications consisted of 1 case of mild cholangitis and 1 recurrence of the anastomotic stricture. Limitations: Nonrandomized study design. Conclusions: MCA safely and effectively resolved post-LDLT biliary duct-to-duct anastomotic strictures that could not be resolved using conventional methods, such as ERCP and percutaneous transhepatic biliary drainage.

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