J Korean Soc Transplant.  2012 Sep;26(3):188-195. 10.4285/jkstn.2012.26.3.188.

New Strategy in Cases of Failed Endoscopic Intervention of Biliary Strictures after Living Donor Liver Transplantation: Percutaneous Transhepatic Biliary Stent Insertion and Subsequent Endoscopic Treatment

• Woo SM
• Kim HB
• Lee KW
• Lee WJ
• Kim YK
• Han SS
• Park SJ

• KMID: 2003534
• DOI: http://doi.org/10.4285/jkstn.2012.26.3.188

Abstract

BACKGROUND
In cases of endoscopic intervention treatment for biliary stricture which fail, a percutaneous approach can be subsequently attempted. However, the quality of life is lower for those patients with percutaneous transhepatic biliary drainage (PTBD) tubes than those with endoscopic retrograde biliary drainage tubes. In this study, we report the outcome of the application of percutaneous transhepatic biliary stenting (PTBS) for use in subsequent endoscopic treatment of biliary stricture after living donor liver transplantation (LDLT).
METHODS
Of 165 patients who underwent LDLT, 40 (24.2%) were diagnosed with anastomotic biliary strictures. Of these patients, seven agreed to treatment using PTBS using a plastic stent with endoscopic follow-up instead of treatment by insertion of a PTBD tube, and were enrolled in this study.
RESULTS
In all seven patients, the use of this technique enabled effective advancement of a guide wire and successful placement of one or two plastic stents (7 or 10 Fr) into the PTBD tract. There were no PTBS-related complications associated with the procedure. The median duration for stent use was 40.3 weeks (range; 27.6~65.0). Upon final removal of all stents, the stricture had been resolved in four (57%) of the seven patients.
CONCLUSIONS
Our study data suggested that, after failed use of ERCP in the treatment of biliary stricture after LDLT, the use of PTBS and ERCP may be an effective and safe treatment.

Keyword

Bile ducts; Complication; Bile duct stent

MeSH Terms

Bile Ducts
Cholangiopancreatography, Endoscopic Retrograde
Constriction, Pathologic
Dioxolanes
Drainage
Fluorocarbons
Follow-Up Studies
Humans
Liver
Liver Transplantation
Living Donors
Plastics
Quality of Life
Stents
Dioxolanes
Fluorocarbons
Plastics

Figure

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  Fig. 1. Among 13 patients who had failure in initial endoscopic approach and received PTBD. Five pa-awho agreed with endotients scopic follow-up instead of PTBD tubes were enrolled this study; Among 6 patients for whom PTBD was done as an initial approach, btwo patients who wanted endoscopic follow-up was also enrolled in this study. Abbreviations: ERC-D, endoscopic retrograde cholangiography with dilation; PTC-D, percutaneous transhepatic cholangiography with dilation.

• 

  Fig. 2. Percutaneous transhepatic biliary stent insertion. (A) The anastomotic stricture before stent insertion. (B) The placement of the guidewires and the insertion of the plastic stent at the anastomotic stricture. (C) The plastic stent left in place after treatment.

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