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Dzaye O, Erinjeri JP, Kingham TP, Cornelis FH. Internalization of an Excluded Bile Duct after Pancreaticoduodenectomy Using a Percutaneous Gun-Sight Approach. J Vasc Interv Radiol 2023:S1051-0443(23)00188-4. [PMID: 36842535 DOI: 10.1016/j.jvir.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Affiliation(s)
- Omar Dzaye
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Weill Cornell Medical College, New York, NY
| | - Joseph P Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Weill Cornell Medical College, New York, NY
| | - T Peter Kingham
- Weill Cornell Medical College, New York, NY; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Weill Cornell Medical College, New York, NY.
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2
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Totally percutaneous rendezvous technique for the treatment of complete biliary obstruction after liver transplant. Radiol Case Rep 2022; 17:1284-1287. [PMID: 35242253 PMCID: PMC8857540 DOI: 10.1016/j.radcr.2022.01.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Biliary complications, including biliary stricture and obstruction, remain a major cause of morbidity and mortality after living donor liver transplantation. In these patients the biliary system may not be accessible by endoscopic approach due to Roux-en-Y hepaticojejunostomy, and a percutaneous approach may be considered to avoid surgical interventions. When there is complete biliary obstruction, the conventional percutaneous approaches may not be successful to cross the hepaticojejunostomy anastomosis. In this study, a totally percutaneous rendezvous technique was used to create a neo-biliary-enteric tract using a trans-biliary Rosch-Uchida needle in a patient with complete biliary obstruction and Roux-en-Y anastomosis after a split liver transplant. A biodegradable stent was placed after recanalization with long-term patency on follow up.
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3
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Chiu Y. Endoscopic management for post‐living donor liver transplantation anastomotic biliary stricture: The common failure‐causing problems and their solutions. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Yi‐Chun Chiu
- Division of Hepato‐Gastroenterology, Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Taiwan
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4
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Bhutiani N, Jones JM, Wei D, Goldstein LJ, Martin RCG, Jones CM, Cannon RM. A cost analysis of early biliary strictures following orthotopic liver transplantation in the United States. Clin Transplant 2018; 32:e13396. [PMID: 30160322 DOI: 10.1111/ctr.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION To date, the financial burden of biliary strictures (BS) after orthotopic liver transplantation (OLT) has remained largely unassessed. This study sought to approximate perioperative costs associated with early BS and delineate where in the hospital these costs are incurred. METHODS The Premier Healthcare Database was queried for patients undergoing OLT between 2010 and 2016. Patients who did and did not develop early BS were compared with respect to perioperative costs and outcome variables. Multivariable regression models were used to estimate differences between groups. RESULTS Patients who developed early BS had a longer length of stay (LOS) (35.3 days vs 17.8 days, P < 0.001) and were less likely to be discharged home (odds ratio = 0.45, P = 0.003). Development of early BS was associated with an incremental cost increase of $81 881 (45.8%, P < 0.001). The greatest relative cost increases were in radiology (+163.5%) and respiratory therapy (+157.1%), while the greatest absolute increase was in room and board (+$27 589). CONCLUSIONS Early BS after OLT result in higher costs stemming from longer LOS and increased need for various diagnostic studies and therapies. In addition to incentivizing measures that may prevent early BS, hospitals should account for these factors when developing payment schemes for OLT with payors.
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Affiliation(s)
- Neal Bhutiani
- Division of Transplantation, Hiram C. Polk Jr, MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Jordan M Jones
- Division of Transplantation, Hiram C. Polk Jr, MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - David Wei
- Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, New Jersey
| | - Laura J Goldstein
- Franchise Health Economics and Market Access, Ethicon, Somerville, New Jersey
| | - Robert C G Martin
- Division of Transplantation, Hiram C. Polk Jr, MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Christopher M Jones
- Division of Transplantation, Hiram C. Polk Jr, MD Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Robert M Cannon
- Division of Transplantation, Hiram C. Polk Jr, MD Department of Surgery, University of Louisville, Louisville, Kentucky
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5
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Woo HY, Lee IS, Chang JH, Youn SB, Bae SH, Choi JY, Chun HJ, You YK, Kim DG, Yoon SK. Outcome of donor biliary complications following living donor liver transplantation. Korean J Intern Med 2018; 33. [PMID: 29529841 PMCID: PMC6030404 DOI: 10.3904/kjim.2017.264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Biliary complications are the most common donor complication following living donor liver transplantation (LDLT). The aim of this study is to investigate the long-term outcomes of biliary complications in right lobe adult-to-adult LDLT donors, and to evaluate the efficacy of endoscopic treatment of these donors. METHODS The medical charts of right lobe donors who developed biliary complications between June 2000 and January 2008 were retrospectively reviewed. RESULTS Of 337 right lobe donors, 49 developed biliary complications, including 36 diagnosed with biliary leakage and 13 with biliary stricture. Multivariate analysis showed that biliary leakage was associated with the number of right lobe bile duct orifices. Sixteen donors, five with leakage and 11 with strictures, underwent endoscopic retrograde cholangiography (ERC). ERC was clinically successful in treating eight of the 11 strictures, one by balloon dilatation and seven by endobiliary stenting. Of the remained three, two were treated by rescue percutaneous biliary drainage and one by conservative care. Of the five patients with leakage, four were successfully treated using endobiliary stents and one with conservative care. In overall, total 35 improved with conservative treatment. All inserted stents were successfully retrieved after a median 264 days (range, 142 to 502) and there were no recurrences of stricture or leakages during a median follow-up of 10.6 years (range, 8 to 15.2). CONCLUSIONS All donors with biliary complications were successfully treated non-surgically, with most improving after endoscopic placement of endobiliary stents and none showing recurrence on long term follow-up.
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Affiliation(s)
- Hyun Young Woo
- Department of Internal Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to In Seok Lee, M.D. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-590-1663 Fax: +82-2-3481-4025 E-mail:
| | - Jae Hyuck Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Bae Youn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Jong Chun
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoung You
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Goo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Kew Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mastier C, Valette PJ, Adham M, Mabrut JY, Glehen O, Ponchon T, Rousset P, Rode A. Complex Biliary Leaks: Effectiveness of Percutaneous Radiological Treatment Compared to Simple Leaks in 101 Patients. Cardiovasc Intervent Radiol 2018; 41:1566-1572. [DOI: 10.1007/s00270-018-2005-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
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Shin M, Joh JW. Advances in endoscopic management of biliary complications after living donor liver transplantation: Comprehensive review of the literature. World J Gastroenterol 2016; 22:6173-6191. [PMID: 27468208 PMCID: PMC4945977 DOI: 10.3748/wjg.v22.i27.6173] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/25/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
Apart from noticeable improvements in surgical techniques and immunosuppressive agents, biliary complications remain the major causes of morbidity and mortality after living donor liver transplantation (LDLT). Bile leakage and stricture are the predominant complications. The reported incidence of biliary complications is 15%-40%, and these are known to occur more frequently in living donors than in deceased donors. Despite the absence of a confirmed therapeutic algorithm, many approaches have been used for treatment, including surgical, endoscopic, and percutaneous transhepatic techniques. In recent years, nonsurgical approaches have largely replaced reoperation. Among these, the endoscopic approach is currently the preferred initial treatment for patients who undergo duct-to-duct biliary reconstruction. Previously, endoscopic management was achieved most optimally through balloon dilatation and single or multiple stents placement. Recently, there have been significant developments in endoscopic devices, such as novel biliary stents, as well as advances in endoscopic technologies, including deep enteroscopy, the rendezvous technique, magnetic compression anastomosis, and direct cholangioscopy. These developments have resulted in almost all patients being managed by the endoscopic approach. Multiple recent publications suggest superior long-term results, with overall success rates ranging from 58% to 75%. This article summarizes the advances in endoscopic management of patients with biliary complications after LDLT.
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Martins FP, Kahaleh M, Ferrari AP. Management of liver transplantation biliary stricture: Results from a tertiary hospital. World J Gastrointest Endosc 2015; 7:747-757. [PMID: 26140103 PMCID: PMC4482835 DOI: 10.4253/wjge.v7.i7.747] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/30/2014] [Accepted: 05/11/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To review results of endoscopic treatment for anastomotic biliary strictures after orthotopic liver transplantation (OLT) during an 8-year period.
METHODS: This is a retrospective review of all endoscopic retrograde cholangiopancreatographys (ERCPs) performed between May 2006 and June 2014 in deceased OLT recipients with anastomotic stricture at a tertiary care hospital. Patients were divided into 2 groups, according to the type of stent used (multiple plastic or covered self-expandable metal stents), which was chose on a case-by-case basis and their characteristics. The primary outcome was anastomotic stricture resolution rate determined if there was no more than a minimum waist at cholangiography and a 10 mm balloon could easily pass through the anastomosis with no need for further intervention after final stent removal. Secondary outcomes were technical success rate, number or ERCPs required per patient, number of stents placed, stent indwelling, stricture recurrence rate and therapy for recurrent anastomotic biliary stricture (AS). Stricture recurrence was defined as clinical laboratorial and/or imaging evidence of obstruction at the anastomosis level, after it was considered completely treated, requiring subsequent interventional procedure.
RESULTS: A total of 195 post-OLT patients were assessed for eligibility. One hundred and sixty-four (164) patients were diagnosed with anastomotic biliary stricture. ERCP was successfully performed in 157/164 (95.7%) patients with AS, that were treated with either multiple plastic (n = 109) or metallic billiary stents (n = 48). Mean treatment duration, number of procedures and stents required were lower in the metal stent group. Acute pancreatitis was the most common procedure related complication, occurring in 17.1% in the covered self-expandable metal stents (cSEMS) and 4.1% in the multiple plastic stent (MPS) group. Migration was the most frequent stent related complication, observed in 4.3% and 5.5% (cSEMS and MPS respectively). Stricture resolution was achieved in 86.8% in the cSEMS group and in 91% in MPS group. Stricture recurrence after a median follow up of 20 mo was observed in 10 (30.3%) patients in the cSEMS and 7 (7.7%) in the plastic stent group, a statistically significant difference (P = 0.0017). Successful stricture resolution after secondary treatment was achieved in 66.6% and 62.5% of patients respectively in the cSEMS and plastic stents groups.
CONCLUSION: Multiple plastic stents are currently the first treatment option for AS in patients with duct-to-duct anastomosis. cSEMS was associated with increased pancreatitis risk and higher recurrence rate.
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Lauterio A, Di Sandro S, Giacomoni A, De Carlis L. The role of adult living donor liver transplantation and recent advances. Expert Rev Gastroenterol Hepatol 2015; 9:431-45. [PMID: 25307897 DOI: 10.1586/17474124.2015.967762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Twenty years since the first cases were described, adult living donor liver transplantation (ALDLT) is now considered a valid option to expand the donor pool in view of the ongoing shortage of organs and the high waiting list mortality rate. Despite the rapid evolution and acceptance of this complex process of donation and transplantation in clinical practice, the indications, outcome, ethical considerations and quality and safety aspects continue to evolve based on new data from large cohort studies. This article reviews the surgical and clinical advances in the field of liver transplantation, focusing on technical refinements and discussing the issues that may lead to a further expansion of this complex surgical procedure and the role of ALDLT.
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Affiliation(s)
- Andrea Lauterio
- Transplant Center, Department of Surgery and Abdominal Transplantation, Niguarda Cà Granda Hospital, Milan, Italy
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10
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Section 11. Radiological intervention approaches to biliary complications after living donor liver transplantation. Transplantation 2014; 97 Suppl 8:S43-6. [PMID: 24849833 DOI: 10.1097/01.tp.0000446275.51428.65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although endoscopic treatment has become the first choice to treat biliary complications, percutaneous transhepatic treatment still has important roles to treat biliary stricture or leak after living donor liver transplantation. This study reviewed a total of 527 recipients who had undergone percutaneous transhepatic treatment to treat biliary stricture (n=498) and leaks (n=29). Percutaneous transhepatic treatment included percutaneous transhepatic biliary drainage, perihepatic biloma drainage, balloon dilation of biliary stricture, and drainage catheter interposition or retrievable covered stent placement across a stricture or leak segment. Clinical success was achieved in 440 (88.4%) recipients with biliary stricture and 19 (65.5%) recipients with bile leaks. Percutaneous transhepatic treatment seems to be an effective alternative for treating biliary complications resistant to or inaccessible by endoscopic treatment.
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11
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Shin M, Joh JW. Section 10. Endoscopic management of biliary complications in adult living donor liver transplantation. Transplantation 2014; 97 Suppl 8:S36-43. [PMID: 24849832 DOI: 10.1097/01.tp.0000446274.13310.b9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Living donor liver transplantation (LDLT) has become an accepted therapeutic option for patients with end-stage liver disease. However, biliary complications remain the major causes of morbidity and mortality for LDLT recipients. Although there are currently no reports of a clear therapeutic algorithm, many approaches have been developed to treat biliary complications, including surgical, endoscopic, and percutaneous transhepatic techniques. Endoscopic treatment is currently the preferred initial treatment for patients that have previously undergone duct-to-duct biliary reconstruction. This article discusses aspects of endoscopic management of biliary complications that occur in adult LDLT.
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Affiliation(s)
- Milljae Shin
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2 Address correspondence to: Jae-Won Joh, M.D., Ph.D., Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea
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12
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Segedi M, Buczkowski AK, Scudamore CH, Yoshida EM, Harris AC, DeGirolamo K, Chung SW. Biliary and vascular anomalies in living liver donors: the role and accuracy of pre-operative radiological mapping. HPB (Oxford) 2013; 15:732-9. [PMID: 23458411 PMCID: PMC3948542 DOI: 10.1111/hpb.12042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/28/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the present study was to determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) anatomic mapping in the detection of biliary and vascular anomalies prior to a living liver donor (LLD) operation. METHODS A retrospective study of all LLD patient charts, operative and radiology reports from 1 January 2002 to 1 January 2012 was conducted. Primary post-operative outcomes assessed included mortality, re-operation, readmission and need for endoscopic or percutaneous intervention. Sensitivity and specificity of MR and CT pre-operative screening was calculated against the gold standard of intra-operative findings. RESULTS A total of 34 donors had an average age of 38 years (range: 22-58) with a body mass index (BMI) of 25.6 kg/m(2) (range: 19.8-32.5) and a length of stay (LOS) of 10.1 days (range: 5-41). There were no donor mortalities. Sensitivity and specificity of CT was 70.0% and 91.3%, and of MRI screening 23.1% and 100.0%, respectively. Patients with inaccurate pre-operative CT or MRI did not have an increased risk of complications. CONCLUSIONS Even although it was specific, pre-operative MR screening missed up to 77.0% of biliary anomalies. An impeccable surgical technique remains the key in preventing biliary complications of a living donor hepatectomy where pre-operative MRI screening is false.
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Affiliation(s)
- Maja Segedi
- Department of Surgery, University of British ColumbiaVancouver, BC, Canada,Correspondence Maja Segedi, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel Street, 5th Floor, Vancouver, BC V5Z 1 M9, Canada. Tel: +1 604 875 4459. Fax: +1 604 675 3973. E-mail:
| | | | | | - Eric M Yoshida
- Department of Medicine, University of British ColumbiaVancouver, BC, Canada
| | - Alison C Harris
- Department of Radiology, University of British ColumbiaVancouver, BC, Canada
| | - Kristin DeGirolamo
- Undergraduate Medicine, University of British ColumbiaVancouver, BC, Canada
| | - Stephen W Chung
- Department of Surgery, University of British ColumbiaVancouver, BC, Canada
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Hepatobiliary Intervention in Children. Cardiovasc Intervent Radiol 2013; 37:37-54. [DOI: 10.1007/s00270-013-0712-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 07/10/2013] [Indexed: 12/17/2022]
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14
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Yoon HM, Kim JH, Ko GY, Song HY, Gwon DI, Sung KB. Alternative techniques for cannulation of biliary strictures resistant to the 0.035" system following living donor liver transplantation. Korean J Radiol 2012; 13:189-94. [PMID: 22438686 PMCID: PMC3303902 DOI: 10.3348/kjr.2012.13.2.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 10/13/2011] [Indexed: 01/29/2023] Open
Abstract
Objective To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique. Subjects and Methods Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches. Results Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision. Conclusion Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.
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Affiliation(s)
- Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
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15
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Lee YY, Gwak GY, Lee KH, Lee JK, Lee KT, Kwon CHD, Joh JW, Lee SK. Predictors of the feasibility of primary endoscopic management of biliary strictures after adult living donor liver transplantation. Liver Transpl 2011; 17:1467-73. [PMID: 21898773 DOI: 10.1002/lt.22432] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Biliary strictures are a major cause of morbidity and mortality for liver transplant recipients. The endoscopic management of biliary strictures is not well established after living donor liver transplantation (LDLT) in comparison with deceased donor liver transplantation. The aims of this study were to assess the initial success rate of primary endoscopic treatment of biliary strictures after LDLT and to identify predictors of the feasibility of endoscopic management. One hundred thirty-seven adult patients who underwent LDLT and were confirmed to have biliary strictures by endoscopic retrograde cholangiopancreatography (ERCP) were enrolled. The biliary strictures were primarily managed endoscopically with internal drainage or nasobiliary catheterization. The initial success rate for the primary endoscopic management of biliary strictures after LDLT was 46.7% (64 of 137 patients), and the feasibility of endoscopic management was associated with the stricture-to-ERCP interval (the interval between the development of the total bilirubin, aspartate aminotransferase, or alanine aminotransferase level to >2 times the upper limit of normal and the performance of ERCP) as well as cholangiographic findings (eg, the stricture morphology and the tip shape of the distal duct). In conclusion, when biliary strictures are noticed after LDLT, prompt endoscopic interventions may improve the initial success rate of primary endoscopic management. In addition, the feasibility of primary endoscopic management can be predicted by the cholangiographic findings, which may help with the choice of the therapeutic modality.
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Affiliation(s)
- Yun Young Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
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Mathur AK, Ranney DN, Patel SP, Lee DS, Bednar F, Lynch RJ, Welling TH, Englesbe MJ. The effect of smoking on biliary complications following liver transplantation. Transpl Int 2010; 24:58-66. [DOI: 10.1111/j.1432-2277.2010.01146.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Duailibi DF, Ribeiro MAF. Biliary complications following deceased and living donor liver transplantation: a review. Transplant Proc 2010; 42:517-20. [PMID: 20304182 DOI: 10.1016/j.transproceed.2010.01.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Biliary complications are the most important source of complications after liver transplantation, and an important cause of morbidity and mortality. With the evolution of surgical transplantation techniques, including living donor and split-liver transplants, the complexity of these problems is increasing. Many studies have shown a higher incidence of biliary tract complications in living donor liver transplantation (LDLT) compared with deceased donor liver transplantation (DDLT). This article reviews biliary complications after liver transplantation and correlations with LDLT and DDLT. OBJECTIVE Provide an overview of biliary complications among LDLT and DDLT. RESULTS The incidence of biliary complications is higher among LDLT (28.7%) when compared with DDLT (15.5%). Bile leaks were the most common complication due to LDLT (17.1%); however, stricture was the most common complication due to DDLT (7.5%).
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Affiliation(s)
- D F Duailibi
- Cidade de São Paulo University-Medical School, São Paulo, Brazil
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Seo JK, Ryu JK, Lee SH, Park JK, Yang KY, Kim YT, Yoon YB, Lee HW, Yi NJ, Suh KS. Endoscopic treatment for biliary stricture after adult living donor liver transplantation. Liver Transpl 2009; 15:369-80. [PMID: 19326412 DOI: 10.1002/lt.21700] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic intervention is considered to be the primary treatment for biliary stricture after adult living donor liver transplantation (LDLT) with duct-to-duct biliary reconstruction. The aim of this study was to investigate the risk factors of biliary stricture and the clinical outcomes and predictors of failure after endoscopic retrograde cholangiography with balloon dilation (ERC-D). We enrolled 239 adult patients who underwent LDLT between 2000 and 2006. Sixty-eight patients (28.4%) developed biliary stricture. Twenty-nine patients with anastomotic biliary stricture were treated with ERC-D and stenting. We retrospectively analyzed the risk factors of biliary stricture and the clinical outcomes of ERC-D. The median follow-up period was 31 months. The risk factors of biliary stricture on multiple logistic regression analysis were a graft with multiple bile ducts, a previous history of bile leakage, and hepatic artery stenosis. The overall success rate of ERC-D was 64.5%. On simple logistic regression, the failure of primary ERC-D was associated with late biliary stricture over 24 weeks and more than 8 weeks between a 2-fold increase of serum alkaline phosphatase from the stable level and ERC-D, even though these were not statistically significant on multiple logistic regression. The relapse rate of stricture after successful ERC-D was 30%. The duration of stenting in the recurrence group was shorter than that in the nonrecurrence group (11.8 +/- 5.03 versus 29.0 +/- 11.6 weeks, P = 0.004). ERC-D is effective for the management of anastomotic biliary stricture. However, the failure rate of primary ERC-D may be high in patients with late onset and delayed diagnosis of biliary stricture. The recurrence seems to occur frequently in patients with a short duration of stenting.
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Affiliation(s)
- Jeong Kyun Seo
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Miraglia R, Maruzzelli L, Caruso S, Marrone G, Carollo V, Spada M, Luca A, Gridelli B. Interventional Radiology Procedures in Pediatric Patients with Complications after Liver Transplantation. Radiographics 2009; 29:567-84. [DOI: 10.1148/rg.292085037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Miraglia R, Maruzzelli L, Caruso S, Milazzo M, Marrone G, Mamone G, Carollo V, Gruttadauria S, Luca A, Gridelli B. Interventional radiology procedures in adult patients who underwent liver transplantation. World J Gastroenterol 2009; 15:684-93. [PMID: 19222091 PMCID: PMC2653436 DOI: 10.3748/wjg.15.684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Interventional radiology has acquired a key role in every liver transplantation (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-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.
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21
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Parsi MA, Guardino J, Vargo JJ. Peroral cholangioscopy-guided stricture therapy in living donor liver transplantation. Liver Transpl 2009; 15:263-5. [PMID: 19177445 DOI: 10.1002/lt.21584] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mansour A Parsi
- Center for Endoscopy and Pancreatobiliary Disorders, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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22
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Jiang XZ, Yan LN, Li B, Zhao JC, Wang WT, Li FG, Wen TF, Ma YK, Zeng Y, Xu MQ, Yang JY, Li ZH. Arterial complications after living-related liver transplantation: single-center experience from West China. Transplant Proc 2008; 40:1525-8. [PMID: 18589143 DOI: 10.1016/j.transproceed.2007.11.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 08/27/2007] [Accepted: 11/09/2007] [Indexed: 02/08/2023]
Abstract
Vascular complications after liver transplantation remain a major source of morbidity and mortality for recipients. In particular, patients receiving living-related liver transplantation (LRLT) experience a higher rate of vascular complications owing to the complex vascular reconstruction. Between July 2001 and December 2005, LRLTs were performed in our center on 33 patients with end-stage liver diseases. The 23 men and 10 women had a mean age of 32.6 +/- 11.3 years (range = 5 to 58 years). Of the 33 patients, the percentage of vascular complications was 9.09% (3 cases), including hepatic arterial thrombosis (HAT), hepatic arterial stenosis (HAS), or hepatic artery pseudoaneurysm (HAP) in one patient, respectively. No portal vein or hepatic vein complication occurred in our patients. Thrombectomy was performed in the patient with thrombosis. The patient with stenosis was treated with balloon angioplasty and endoluminal stent placement. The pseudoaneurysm was also successfully embolized to restore the blood flow toward the donor liver. Mean follow-up for all patients after LRLT was 18.0 +/- 5.4 months. The overall postoperative 30-day mortality rate was 6.06% (2/33). The 1-year survival rate was 86.36% in 22 patients with benign diseases and 72.73% in 11 patients with malignant diseases. However, no death was associated with vascular complications. Careful preoperative evaluation and intraoperative microsurgical technique for hepatic artery reconstructions are the keys to prevent vascular complications following LRLT. Immediate surgical intervention is required for acute vascular complications, whereas late complications may be treated by balloon angioplasty and endoluminal stent placement. Embolization may be a safe and effective approach in the treatment of a pseudoaneurysm of the hepatic artery.
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Affiliation(s)
- X-Z Jiang
- Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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23
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Kim JH, Ko GY, Sung KB, Yoon HK, Gwon DI, Kim KR, Lee SG. Bile leak following living donor liver transplantation: clinical efficacy of percutaneous transhepatic treatment. Liver Transpl 2008; 14:1142-9. [PMID: 18668647 DOI: 10.1002/lt.21501] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Percutaneous transhepatic treatment may be effective in patients with bile leaks after living donor liver transplantation (LDLT). We therefore evaluated the clinical efficacy of percutaneous transhepatic treatment for biliary leaks in adult-to-adult LDLT recipients. Twenty-three LDLT recipients underwent percutaneous transhepatic treatment to manage bile leaks. The treatment included percutaneous transhepatic biliary drainage (PTBD) and drainage of perihepatic biloma. In patients with combined biliary strictures, balloon dilation was usually performed. Indications for PTBD included patients who had a Roux-en-Y hepaticojejunostomy (n = 9), failed endoscopic cannulation of bile ducts (n = 6), a bile leak refractory to endoscopic management (n = 5), and a poor general condition for endoscopic management (n = 3). Clinical success was achieved in 16 of 23 (70%) patients. PTBD catheters were removed from 14 of the 16 patients with clinical success at a median of 8 months (range, 3-42 months) after initial PTBD. Aside from 1 patient with intrahepatic pseudoaneurysms, there were no major complications. During a median follow-up period of 42 months (range, 3.0-84 months), 6 (43%) of the 14 patients who underwent PTBD catheter removal experienced jaundice or cholangitis due to biliary anastomotic stricture at a median of 26 months (range, 22-49 months) after PTBD catheter removal. In conclusion, percutaneous transhepatic treatment for biliary leaks in adult-to-adult LDLT recipients is clinically effective. This approach is a valuable alternative for treating bile leaks resistant to or inaccessible by endoscopic methods. However, further investigations are needed to minimize the duration of treatment and biliary strictures following PTBD catheter removal.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, Seoul, Korea
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24
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Righi D, Doriguzzi A, Rampado O, Savio L, Faletti R, Caggiula P, Ropolo R, Gandini G. Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects. Radiol Med 2008; 113:429-38. [DOI: 10.1007/s11547-008-0252-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 06/11/2007] [Indexed: 11/30/2022]
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25
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Lee SH, Ryu JK, Woo SM, Park JK, Yoo JW, Kim YT, Yoon YB, Suh KS, Yi NJ, Lee JM, Han JK. Optimal interventional treatment and long-term outcomes for biliary stricture after liver transplantation. Clin Transplant 2008; 22:484-93. [PMID: 18318735 DOI: 10.1111/j.1399-0012.2008.00813.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We undertook an evaluation of the clinical outcomes of endoscopic cholangioplasty (ECP) and percutaneous cholangioplasty (PCP) for biliary strictures after liver transplantation. We compared success rates of intervention, patency after successful intervention and procedure-related morbidities in 79 patients with anastomotic stricture (n = 54) or non-anastomotic stricture (n = 25). Twenty-five ECP and 61 PCP procedures were performed; seven PCP procedures were consecutively performed after failure of ECP. Fifty-one (64.6%) patients were successfully treated by cholangioplasty. Successful intervention rates (60.0% in ECP vs. 59.3% in PCP, p = 1.00) and patencies after successful intervention (44.8 +/- 7.4 months in ECP vs. 41.9 +/- 3.4 months in PCP, p = 0.47) were no different for the two techniques. However, the number of intervention sessions for PCP (7.2 +/- 0.6) was higher than for ECP (2.9 +/- 0.6) (p < 0.01). Multivariate analysis showed that only an anastomotic stricture was found to be related with a longer patency with an estimated odds ratio of 5.74 (p = 0.04) and had a tendency to be associated with successful intervention with an estimated odds ratio of 3.12 (p = 0.07) irrespective of techniques. Endoscopic access should be the preferred first approach in patients with biliary stricture after liver transplantation irrespective of the type of stricture, in view of its less invasive nature and patient convenience.
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Affiliation(s)
- Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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26
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Haskal ZJ, Brown RS. Role of Biliary Stress Manometry after Biliary Stricture Dilation in Living Donor Liver Transplant Recipients. J Vasc Interv Radiol 2008; 19:216-9. [DOI: 10.1016/j.jvir.2007.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 09/16/2007] [Accepted: 09/17/2007] [Indexed: 11/26/2022] Open
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27
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Miraglia R, Traina M, Maruzzelli L, Caruso S, Di Pisa M, Gruttadauria S, Luca A, Gridelli B. Usefulness of the "rendezvous" technique in living related right liver donors with postoperative biliary leakage from bile duct anastomosis. Cardiovasc Intervent Radiol 2008; 31:999-1002. [PMID: 18196331 DOI: 10.1007/s00270-007-9276-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 12/05/2007] [Accepted: 12/06/2007] [Indexed: 12/11/2022]
Abstract
This is a report on two cases of large bile leak following right hepatectomy performed for living related liver transplantation, originating from the stump of the ligated right bile duct, and treated with the placement of large percutaneous biliary catheters through a combined percutaneous transhepatic and endoscopic approach (rendezvous technique).
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Affiliation(s)
- R Miraglia
- Department of Radiology, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Via Tricomi 1, 90127, Palermo, Italy.
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28
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Németh A, Doros A, Hartmann E, Járay J. [Imaging techniques for the pre- and postoperative evaluation of recipients with living-donor liver transplantation]. Orv Hetil 2008; 149:69-76. [PMID: 18093897 DOI: 10.1556/oh.2008.28208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Whole-liver transplantation is a worldwide-accepted method for treatment of end-stage liver disease. As a result of the shortage of cadaveric livers, split-liver transplantation and living-donor liver transplantation are becoming more common. Preoperative imaging of the donors and recipients are indispensable for surgery planning, while postoperative imaging highly contributes to the success of transplantation by follow-up the transplanted organ and early diagnosis of possible sequelae. The authors delineate both pre- and postoperative imaging of recipients of living-donor transplantation, including the role of conventional x-ray, ultrasound, CT and MRI techniques, and also the different possibilities in the field of interventional radiology.
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Affiliation(s)
- Andrea Németh
- Semmelweis Egyetem, Altalános Orvostudományi Kar Transzplantációs és Sebészeti Klinika Budapest Baross u. 23-25. 1082.
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29
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Akita H, Hikita H, Yamanouchi E, Marubashi S, Nagano H, Umeshita K, Dono K, Tsutsui S, Hayashi N, Monden M. Use of a metallic-wall stent in the magnet compression anastomosis technique for bile duct obstruction after liver transplantation. Liver Transpl 2008; 14:118-20. [PMID: 18161766 DOI: 10.1002/lt.21273] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hirofumi Akita
- Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan
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30
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Shami VM, Talreja JP, Mahajan A, Phillips MS, Yeaton P, Kahaleh M. EUS-guided drainage of bilomas: a new alternative? Gastrointest Endosc 2008; 67:136-40. [PMID: 18155436 DOI: 10.1016/j.gie.2007.07.040] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 07/23/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bilomas have traditionally been treated by either percutaneous drainage or surgery. However, percutaneous drainage is associated with discomfort and infection, whereas surgery, which is usually reserved for refractory cases, has high morbidity and mortality rates. Recently, endoscopic drainage of bilomas adjacent to the GI lumen has been reported in isolated reports. OBJECTIVE We analyzed our 4 years' experience with this innovative technique. DESIGN Patients with symptomatic bilomas were offered EUS-guided drainage and were followed up prospectively for clinical and radiologic responses. SETTING Tertiary care center with long-standing experience in EUS-guided drainage. PATIENTS A total of 5 patients underwent EUS-guided transenteric drainage of symptomatic bilomas. INTERVENTION The technique included transenteric EUS-guided puncture, placement of a guidewire into the biloma, and creation of an enteral-biloma fistula with placement of a plastic endoprosthesis after balloon dilation. In 4 cases, the stents were removed at a mean of 6.8 +/- 4.3 weeks. In one patient with malignancy, the stent was left in place for palliation. MAIN OUTCOME MEASUREMENTS Efficacy and safety of EUS-guided drainage of bilomas. RESULTS EUS-guided transenteric biloma drainage was successfully performed in 5 patients without any significant morbidity. Biloma resolution was confirmed in all 5 patients, and none of the 4 patients relapsed after stent removal (mean follow-up of 12.8 +/- 6.1 months). CONCLUSIONS EUS-guided drainage of bilomas is technically feasible, appears safe, and provides an attractive alternative to percutaneous or surgical drainage.
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Aytekin C, Boyvat F, Harman A, Ozyer U, Karakayali H, Haberal M. Percutaneous Therapy for Anastomotic Bile Leak in Liver-Transplant Patients with Nondilated Bile Ducts. Cardiovasc Intervent Radiol 2007; 30:761-4. [PMID: 17533535 DOI: 10.1007/s00270-007-9078-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 02/12/2007] [Accepted: 04/01/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Cuneyt Aytekin
- Department of Radiology and General Surgery, Baskent University Hospital, Fevzi Cakmak cad. 10, sok. No. 45, Bahcelievler, Ankara, 06490, Turkey.
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32
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Abstract
Liver transplantation was pioneered by Starzl and his team in 1967. Since then, many difficulties have been overcome and this treatment modality has gained worldwide acceptance as the definitive treatment for end-stage liver disease. However, the current numbers of liver transplantations are still far below what is needed, the rising numbers on waiting lists have pushed transplant surgeons to search for new alternatives, and living related donors are considered one solution. At our center, the only living liver donors we accept are relatives and spouses of recipients. We have held the same policy for our kidney program from the beginning. In the past 3 years, we have increased the annual numbers of liver transplantations; our graft and patient survival rates for this period exceed 90%. Liver grafts donated by living related donors offer an extremely important, lifesaving alternative in urgent situations, such as acute liver failure, where there is limited time to wait for a deceased donor. Hepatocellular carcinoma is another important indication for living related liver transplantation. Availability of living donors allows us to perform transplantations even in recipients with advanced tumors who would not be accepted as appropriate transplant candidates according to widely used selection criteria. Liver transplantation is a lifesaving procedure that presents many challenges, and our experience has led us to develop an innovative technique for biliary reconstruction. We have used a method of "back-table guide-wire placement and intraoperative transhepatic biliary catheter insertion" in 44 patients since December 2004 to significantly decrease biliary complications and perform duct-to-duct anastomosis even in small pediatric recipients.
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Affiliation(s)
- M Haberal
- Başkent University Faculty of Medicine, Department of General Surgery, Transplantation and Burn Institutions, No. 77 Kat: 4 Bahçelievler 06490, Ankara, Turkey.
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