Ann Hepatobiliary Pancreat Surg.  2023 Feb;27(1):49-55. 10.14701/ahbps.22-037.

Outcomes of endoscopic retrograde cholangiography and percutaneous transhepatic biliary drainage in liver transplant recipients with a Roux-en-Y biliary-enteric anastomosis

• Kohli DR
• Aqel BA
• Segaran NL
• Harrison ME
• Fukami N
• Faigel DO
• Moss A
• Mathur A
• Hewitt W
• Katariya N
• Pannala R

• KMID: 2539513
• DOI: http://doi.org/10.14701/ahbps.22-037

Abstract

Backgrounds/Aims
Data regarding outcomes of endoscopic retrograde cholangiography (ERC) in liver transplant (LT) recipients with biliary-enteric (BE) anastomosis are limited. We report outcomes of ERC and percutaneous transhepatic biliary drainage (PTBD) as first-line therapies in LT recipients with BE anastomosis.
Methods
All LT recipients with Roux-BE anastomosis from 2001 to 2020 were divided into ERC and PTBD subgroups. Technical success was defined as the ability to cannulate the bile duct. Clinical success was defined as the ability to perform cholangiography and therapeutic interventions.
Results
A total of 36 LT recipients (25 males, age 53.5 ± 13 years) with Roux-BE anastomosis who underwent biliary intervention were identified. The most common indications for a BE anastomosis were primary sclerosing cholangitis (n = 14) and duct size mismatch (n = 10). Among the 29 patients who initially underwent ERC, technical success and clinical success were achieved in 24 (82.8%) and 22 (75.9%) patients, respectively. The initial endoscope used for the ERC was a single balloon enteroscope in 16 patients, a double balloon enteroscope in 7 patients, a pediatric colonoscope in 5 patients, and a conventional reusable duodenoscope in 1 patient. Among the 7 patients who underwent PTBD as the initial therapy, six (85.7%) achieved technical and clinical success (p = 0.57).
Conclusions
In LT patients with Roux-BE anastomosis requiring biliary intervention, ERC with a balloon-assisted enteroscope is safe with a success rate comparable to PTBD. Both ERC and PTBD can be considered as first-line therapies for LT recipients with a BE anastomosis.

Keyword

Liver transplantation; Roux-en-Y anastomosis; Endoscopy; Biliary tract diseases

Figure

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  Fig. 1 Liver transplant recipients with Roux-en-Y BE anastomosis. BE, biliary enteric; ERC, endoscopic retrograde cholangiography; PTBD, percutaneous transhepatic biliary drainage.

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  Fig. 2 Endoscopic retrograde cholangiography in a liver transplant recipient with biliary-enteric anastomosis.

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