Balloon dilation only versus balloon dilation plus stenting for posttransplantation biliary strictures

[Endoscopic management of complications in the hepatobiliary and pancreatic system and the tracheobronchial tree]

Endoscopic methods are nowadays a priceless tool for the treatment of postoperative complications after hepatobiliary, pancreatic and thoracic surgery. Endoscopic decompression of the biliary tract is the treatment of choice for biliary duct leakage after cholecystectomy, hepatic resection or liver transplantation. Postoperative biliary duct stenosis can also be successfully treated by endoscopic balloon dilatation and implantation of various endoprostheses in most of the patients. In the case of pancreatic fistulas, especially those occurring after central or distal pancreatic resections, endoscopic decompression of the pancreatic duct can significantly contribute to rapid healing. Additionally, interventional endosonography provides a valuable treatment option for transgastric drainage of postoperative fluid collections, which often accompany a pancreatic fistula. Various treatment alternatives have been described for the bronchoscopic treatment of bronchopleural and tracheoesophageal fistulas, which often lead to the rapid alleviation of symptoms and often to the definitive closure of the fistula.

Interventional radiology in living donor liver transplant

The shortage of deceased donor liver grafts led to the use of living donor liver transplant (LDLT). Patients who undergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation (LT). Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplant. The aim of this paper is to review indications, diagnostic modalities, technical considerations, achievements and potential complications of interventional radiology procedures after LDLT.

Interventional treatment of lumen-reconstruction-related complications after pediatric living-donor liver transplantation

BACKGROUND

Interventional radiology has recently been reported as an effective means of treating complications after liver transplantation. In children, however, the number of such reports is relatively small. In addition, there is ongoing discussion regarding the best interventional devices and methods for specific complications.

OBJECTIVE

The aim of this study was to determine the value of interventional treatment for vessel and bile duct complications after pediatric living-donor liver transplantation.

MATERIALS AND METHODS

Six cases with lumen-reconstruction-related complications after liver transplantation received intervention. Three cases had hepatic artery thrombosis, one had portal vein stenosis, and two had bilioenteric anastomotic stenosis. Catheter-directed thrombolysis was used to treat cases with hepatic artery thrombosis; balloon dilation and stent placement were used for portal vein stenosis; balloon dilation and drainage were used for bilioenteric anastomotic stenosis.

RESULTS

All interventions were performed successfully, and treatment efficacy was 100 %. Except for one death from multiple organ failure, all other cases survived through follow-up, which lasted up to 18 months. No case had intervention-related complication.

CONCLUSION

Interventional treatment is safe and effective, and can be the first choice for the treatment of complications associated with pediatric living-donor liver transplantation.