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Iwasawa S, Tamura M, Okamura T, Torikai H, Ito N, Inoue M, Yamada Y, Jinzaki M, Kuroda T, Nakatsuka S. A Case of Severe Biliary Anastomotic Stricture after Living Donor Liver Transplantation Successfully Treated Using the Modified Gunsight Technique with Two Balloon Catheters. INTERVENTIONAL RADIOLOGY 2021; 6:65-68. [PMID: 35909914 PMCID: PMC9327353 DOI: 10.22575/interventionalradiology.2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/08/2021] [Indexed: 11/03/2022]
Abstract
Biliary stricture is a serious postoperative complication of liver transplantation. We report the case of a 2-year-old boy with severe biliary anastomotic stricture after left lobe living donor liver transplantation. As cannulation from the occluded B3 into the jejunum was impossible using the conventional technique, a gunsight approach was utilized. By puncturing balloons dilated at the occluded site of B3 and the proximal end of the non-occlusive B2, a tract between B3 and B2 was created, and the catheter was finally successfully inserted from B3 into the jejunum through the dilated tract and B2. The gunsight approach is an option for severe biliary strictures when the conventional approach proves impossible.
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Affiliation(s)
- Sayuri Iwasawa
- Department of Radiology, Tokyo Saiseikai Central Hospital, Tokyo
| | - Masashi Tamura
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Teppei Okamura
- Department of Diagnostic Radiology, KKR-Tachikawa Hospital, Tokyo
| | - Hideyuki Torikai
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Nobutake Ito
- Department of Radiology, Tokyo Saiseikai Central Hospital, Tokyo
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo
| | - Seishi Nakatsuka
- Department of Radiology, Keio University School of Medicine, Tokyo
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Horinouchi H, Ueshima E, Sofue K, Komatsu S, Okada T, Yamaguchi M, Fukumoto T, Sugimoto K, Murakami T. Extraluminal recanalization for postoperative biliary obstruction using transseptal needle. Surg Case Rep 2020; 6:304. [PMID: 33270174 PMCID: PMC7714871 DOI: 10.1186/s40792-020-01080-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. CASE PRESENTATION A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal-external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. CONCLUSIONS Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.
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Affiliation(s)
- Hiroki Horinouchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan. .,Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan
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Technical review of a single-center experience of biliary recanalization for liver transplantation-related benign biliary stricture. Eur J Radiol Open 2020; 7:100301. [PMID: 33304944 PMCID: PMC7711208 DOI: 10.1016/j.ejro.2020.100301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To review a single-center experience of percutaneous biliary recanalization for liver transplantation-related benign biliary stricture, particularly focusing on the technical aspect Method Twenty-three recipients of liver transplantation (LT) with 27 benign biliary strictures underwent percutaneous recanalization using a step-by-step technique from June 2017 to March 2020. The step-by-step technique includes a hairy wire or an usual 0.035-inch wire passage, a coaxial system, supporting catheters of various shapes and wires, and an extraluminal passage. The success rate of percutaneous biliary recanalization, degree of stricture, interval between LT and biliary recanalization, procedure time, number of sessions, and recanalization techniques were analyzed. Results Among the 27 lesions, 26 (96 %) were successfully recanalized using a percutaneous approach without major complications. Of the 27 lesions, 8 were complete obstructions and 19 were partial obstructions. Consequently, the average interval between LT and biliary recanalization was 28.8 ± 42.7 months (range, 2–192 months). The average procedure time was 50 ± 65 min (range, 8–345 min). The average number of sessions was 1.4 ± 1 (range, 1–6). The case distribution for the used recanalization techniques was as follows: twelve cases utilized step 1, 10 utilized step 2, 4 utilized step 3, and only 1 case utilized step 4. The complete obstruction group required a more advanced technique and spent more recanalization time than the partial obstruction group. Conclusions The step-by-step percutaneous biliary recanalization technique had a high success rate without major complications. According to the patient’s biliary anatomy appropriate selection of an angled 5-Fr support catheter and wire is essential in increasing the recanalization success rate.
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Lee JH, Yoon CJ, Choi WS, Lee CH. Benign postoperative hepaticojejunostomy stricture: percutaneous recanalisation using the reverse end of a microwire. Clin Radiol 2020; 75:879.e1-879.e6. [PMID: 32727657 DOI: 10.1016/j.crad.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/23/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the technical feasibility and safety of percutaneous recanalisation of benign postoperative hepaticojejunostomy strictures using the reverse end of a microwire. MATERIALS AND METHODS Twenty-one patients with benign postoperative hepaticojejunostomy strictures that had failed to recanalise following management with conventional percutaneous techniques from January 2012 to March 2019 were included in the study. The stricture was punctured by the reverse end of a microwire. Subsequently, serial balloon dilatation and covered stent placement was performed. Technical as well as clinical success, complications, and patency of the hepaticojejunostomy were evaluated. RESULTS Technical success was achieved in 19 of 21 (90.5%) patients. The mean number of treatment sessions was 1.2 (range, 1-2). The obstructive symptoms were resolved within 3 days after the procedure in 19 patients (100%). There were no major complications. The 1-year and 3-year patency rates were 76.9% and 61.5%, respectively. CONCLUSION Percutaneous recanalisation using the reverse end of a microwire is technically feasible and safe in the treatment of benign postoperative hepaticojejunostomy strictures. This technique is useful when the conventional percutaneous technique cannot be used to cross the stricture.
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Affiliation(s)
- J H Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea
| | - C J Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea.
| | - W S Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea
| | - C-H Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea
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Extraluminal Recanalization of Bile Duct Anastomosis Obstruction after Liver Transplantation. J Vasc Interv Radiol 2018; 29:1466-1471. [DOI: 10.1016/j.jvir.2018.02.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 12/12/2022] Open
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