9. Geraer Arbeitstagung: Longitudinale und radiale Endosonografie mit Interventionen – Reflexionen von Veranstalter & Teilnehmer

[A 61-year-old man with jaundice following stomach cancer]

A 61-year-old man with occlusion of the common bile duct due to metachronous metastases after surgery for adenocarcinoma of the stomach underwent a bile drainage intervention using endoscopic ultrasound (EUS). A self-expanding metal stent was inserted into the common bile duct of the liver via the esophagus. Successful drainage of the bile fluid into the duodenum was achieved for 14 months until the death of the patient. EUS interventions are becoming increasingly common. Although many questions such as the methodological details still remain, EUS interventions have the potential to become standard procedures especially in the situation of malignant stenoses of the bile or pancreatic duct.

Biliary complications after liver transplantation

Biliary complications (BCs) remain one of the most outstanding factors influencing long-term results after orthotopic liver transplantation. The authors carried out a systematic overview of 1720 papers since 2008, and focused on 45 relevant ones. Among 14,411 transplanted patients the incidence of BCs was 23%. Biliary leakage occurred in 8.5%, biliary stricture in 14.7%, mortality rate was 1-3%.

RISK FACTORS

preoperative sodium level; p = 0.037, model of end-stage liver disease score >25; p = 0.048, primary sclerosing cholangitis; p = 0.001, malignancy; p = 0.026, donor age >60, macrovesicular graft steatosis; p = 0.001, duct-to-duct anastomosis; p = 0.004, long anhepatic phase; p = 0.04, cold ischemic time >12 h; p = 0.043, use of T-tube; p = 0.032, insufficient flush of bile ducts; p = 0.001, acute rejection; p = 0.003, cytomegalovirus infection; p = 0.004 and hepatic artery thrombosis; p = 0.001. The management was surgical in case of biliary leakage, and interventional radiology or endoscopic retrograde cholangiopancreatography in case of biliary stricture. Mapping of miRNA profile is a new field of research. Nemes-Doros score is a useful tool in the estimation of hepatic artery thrombosis. Management of BCs requires a multidisciplinary expert team.