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Zhang W, Sun H, Dong D, Li Y. Safety and feasibility of a novel recanalization technique using guidewire puncture under cholangioscopy for complete biliary stricture after liver transplantation. Sci Rep 2023; 13:4874. [PMID: 36966204 PMCID: PMC10039916 DOI: 10.1038/s41598-023-31475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/13/2023] [Indexed: 03/27/2023] Open
Abstract
Cholangioscopy is reportedly useful for selective guidewire placement across difficult biliary strictures, but few methods are available for complete stricture of biliary anastomosis. This study aimed to propose a guidewire puncture technique to recanalize totally obstructed anastomosis and discuss its safety and feasibility. From January 2015 to December 2021, a total of 11 patients with complete biliary anastomotic stricture after liver transplantation were enrolled. These patients underwent peroral single operator cholangioscopy (SpyGlass), whereas two failed cases on SpyGlass finally underwent percutaneous transhepatic cholangioscopy (PTCS). The steps of the recanalization technique were as follows: the stricture was viewed carefully to detect the closure point (CP) of the scar endoscopically, then the CP was targeted by the hard tip of the guidewire and broke through under guidance of the cholangioscope and fluoroscope. Complete occlusions were confirmed by SpyGlass in all cases. A total of 13 hard-tip guidewire punctures were performed under cholangioscopy, and ten punctures were successful (technical success rate, 76.9% [10/13]). After recanalization of the occluded anastomosis, plastic stent or metallic stent was deployed in three and seven patients, respectively. No procedure-related complications occurred during or after the cholangioscopy-assisted guidewire puncture. After a mean follow-up of 12 months, stents had been removed in five patients. The other six patients were still receiving stent treatment. This study demonstrated that the guidewire puncture technique under cholangioscopy is safe and feasible for complete stricture of biliary anastomosis, and the success rate is satisfactory.
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Affiliation(s)
- Wei Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Xi'an, 710061, China
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, China
| | - Hao Sun
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, China
| | - Dinghui Dong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Xi'an, 710061, China
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, China
| | - Yu Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi Province, China.
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Xi'an, 710061, China.
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, China.
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Advances in Therapeutic Cholangioscopy. Gastroenterol Res Pract 2016; 2016:5249152. [PMID: 27403156 PMCID: PMC4925961 DOI: 10.1155/2016/5249152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 12/15/2022] Open
Abstract
Nowadays, cholangioscopy is an established modality in diagnostic and treatment of pancreaticobiliary diseases. The more widespread use and the recent development of new technologies and accessories had renewed the interest of endoscopic visualization of the biliary tract, increasing the range of indications and therapeutic procedures, such as diagnostic of indeterminate biliary strictures, lithotripsy of difficult bile duct stones, ablative techniques for intraductal malignancies, removal of foreign bodies and gallbladder drainage. These endoscopic interventions will probably be the last frontier in the near future. This paper presents the new advances in therapeutic cholangioscopy, focusing on the current clinical applications and on research areas.
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