Percutaneous transhepatic biliary drainage may serve as a successful rescue procedure in failed cases of endoscopic therapy for a post-living donor liver transplantation biliary stricture

Eak Seong Kim, Byung Jun Lee, Jong Yun Won, Jong Yong Choi, DongKi Lee

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Although a biliary stricture is one of the most important complications that develop after living donor liver transplantation (LDLT), a standard approach has not yet been established. Objective: The aim of this study was to evaluate the usefulness of nonoperative management in repairing a post-LDLT biliary stricture. Design: A total of 60 patients were referred, from July 2004 to July 2007, for management of a post-LDLT biliary stricture. The patients had ERCP if the hepatic arterial flow was patent on a Doppler sonography. If endoscopic therapy failed, then percutaneous transhepatic drainage (PTBD) was performed to dilate the stricture. If the percutaneous approach also failed, then a repeated PTBD was performed after a 3-dimensional abdominal CT (3D-CT). Setting: Division of Gastroenterology, Department of Internal Medicine, Yongdong Severance Hospital. Patients: Sixty patients were referred from Catholic University Hospital of Korea for ERCP. Results: ERCP was performed on all 60 patients, and 38 (63%) were successfully treated. When the shape of the distal side of the bile-duct anastomosis was classified into 3 categories (pouched, triangular, and intermediate), the pouched shape showed the lowest success rate of endoscopic therapy (25% [4/16]). Fifteen of 22 patients in whom endoscopic therapy failed were treated by using PTBD. Nine of the 15 patients were successfully managed in the first PTBD attempt, and 4 of the 6 patients in whom the first attempt of PTBD failed had repeated PTBD after a 3D-CT. Four patients were successfully treated with repeated PTBD of the alternative branch approach after a 3D-CT. Conclusions: ERCP is a feasible first modality in the treatment of a post-LDLT biliary stricture, but, in failed cases, especially in the pouched shape, PTBD can be attempted. When initial PTBD trial fails, a biliary-tract examination, such as a 3D-CT, can be useful for a repeated PTBD trial.

Original languageEnglish
Pages (from-to)38-46
Number of pages9
JournalGastrointestinal Endoscopy
Volume69
Issue number1
DOIs
Publication statusPublished - 2009 Jan 1

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Living Donors
Liver Transplantation
Drainage
Pathologic Constriction
Endoscopic Retrograde Cholangiopancreatography
Therapeutics
perfluoro-2,2,2',2'-tetramethyl-4,4'-bis(1,3-dioxolane)
Doppler Ultrasonography
Biliary Tract
Gastroenterology
Korea
Internal Medicine
Bile Ducts

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Percutaneous transhepatic biliary drainage may serve as a successful rescue procedure in failed cases of endoscopic therapy for a post-living donor liver transplantation biliary stricture",
abstract = "Background: Although a biliary stricture is one of the most important complications that develop after living donor liver transplantation (LDLT), a standard approach has not yet been established. Objective: The aim of this study was to evaluate the usefulness of nonoperative management in repairing a post-LDLT biliary stricture. Design: A total of 60 patients were referred, from July 2004 to July 2007, for management of a post-LDLT biliary stricture. The patients had ERCP if the hepatic arterial flow was patent on a Doppler sonography. If endoscopic therapy failed, then percutaneous transhepatic drainage (PTBD) was performed to dilate the stricture. If the percutaneous approach also failed, then a repeated PTBD was performed after a 3-dimensional abdominal CT (3D-CT). Setting: Division of Gastroenterology, Department of Internal Medicine, Yongdong Severance Hospital. Patients: Sixty patients were referred from Catholic University Hospital of Korea for ERCP. Results: ERCP was performed on all 60 patients, and 38 (63{\%}) were successfully treated. When the shape of the distal side of the bile-duct anastomosis was classified into 3 categories (pouched, triangular, and intermediate), the pouched shape showed the lowest success rate of endoscopic therapy (25{\%} [4/16]). Fifteen of 22 patients in whom endoscopic therapy failed were treated by using PTBD. Nine of the 15 patients were successfully managed in the first PTBD attempt, and 4 of the 6 patients in whom the first attempt of PTBD failed had repeated PTBD after a 3D-CT. Four patients were successfully treated with repeated PTBD of the alternative branch approach after a 3D-CT. Conclusions: ERCP is a feasible first modality in the treatment of a post-LDLT biliary stricture, but, in failed cases, especially in the pouched shape, PTBD can be attempted. When initial PTBD trial fails, a biliary-tract examination, such as a 3D-CT, can be useful for a repeated PTBD trial.",
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Percutaneous transhepatic biliary drainage may serve as a successful rescue procedure in failed cases of endoscopic therapy for a post-living donor liver transplantation biliary stricture. / Kim, Eak Seong; Lee, Byung Jun; Won, Jong Yun; Choi, Jong Yong; Lee, DongKi.

In: Gastrointestinal Endoscopy, Vol. 69, No. 1, 01.01.2009, p. 38-46.

Research output: Contribution to journalArticle

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N2 - Background: Although a biliary stricture is one of the most important complications that develop after living donor liver transplantation (LDLT), a standard approach has not yet been established. Objective: The aim of this study was to evaluate the usefulness of nonoperative management in repairing a post-LDLT biliary stricture. Design: A total of 60 patients were referred, from July 2004 to July 2007, for management of a post-LDLT biliary stricture. The patients had ERCP if the hepatic arterial flow was patent on a Doppler sonography. If endoscopic therapy failed, then percutaneous transhepatic drainage (PTBD) was performed to dilate the stricture. If the percutaneous approach also failed, then a repeated PTBD was performed after a 3-dimensional abdominal CT (3D-CT). Setting: Division of Gastroenterology, Department of Internal Medicine, Yongdong Severance Hospital. Patients: Sixty patients were referred from Catholic University Hospital of Korea for ERCP. Results: ERCP was performed on all 60 patients, and 38 (63%) were successfully treated. When the shape of the distal side of the bile-duct anastomosis was classified into 3 categories (pouched, triangular, and intermediate), the pouched shape showed the lowest success rate of endoscopic therapy (25% [4/16]). Fifteen of 22 patients in whom endoscopic therapy failed were treated by using PTBD. Nine of the 15 patients were successfully managed in the first PTBD attempt, and 4 of the 6 patients in whom the first attempt of PTBD failed had repeated PTBD after a 3D-CT. Four patients were successfully treated with repeated PTBD of the alternative branch approach after a 3D-CT. Conclusions: ERCP is a feasible first modality in the treatment of a post-LDLT biliary stricture, but, in failed cases, especially in the pouched shape, PTBD can be attempted. When initial PTBD trial fails, a biliary-tract examination, such as a 3D-CT, can be useful for a repeated PTBD trial.

AB - Background: Although a biliary stricture is one of the most important complications that develop after living donor liver transplantation (LDLT), a standard approach has not yet been established. Objective: The aim of this study was to evaluate the usefulness of nonoperative management in repairing a post-LDLT biliary stricture. Design: A total of 60 patients were referred, from July 2004 to July 2007, for management of a post-LDLT biliary stricture. The patients had ERCP if the hepatic arterial flow was patent on a Doppler sonography. If endoscopic therapy failed, then percutaneous transhepatic drainage (PTBD) was performed to dilate the stricture. If the percutaneous approach also failed, then a repeated PTBD was performed after a 3-dimensional abdominal CT (3D-CT). Setting: Division of Gastroenterology, Department of Internal Medicine, Yongdong Severance Hospital. Patients: Sixty patients were referred from Catholic University Hospital of Korea for ERCP. Results: ERCP was performed on all 60 patients, and 38 (63%) were successfully treated. When the shape of the distal side of the bile-duct anastomosis was classified into 3 categories (pouched, triangular, and intermediate), the pouched shape showed the lowest success rate of endoscopic therapy (25% [4/16]). Fifteen of 22 patients in whom endoscopic therapy failed were treated by using PTBD. Nine of the 15 patients were successfully managed in the first PTBD attempt, and 4 of the 6 patients in whom the first attempt of PTBD failed had repeated PTBD after a 3D-CT. Four patients were successfully treated with repeated PTBD of the alternative branch approach after a 3D-CT. Conclusions: ERCP is a feasible first modality in the treatment of a post-LDLT biliary stricture, but, in failed cases, especially in the pouched shape, PTBD can be attempted. When initial PTBD trial fails, a biliary-tract examination, such as a 3D-CT, can be useful for a repeated PTBD trial.

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