Korean J Radiol.  2006 Mar;7(1):41-49. 10.3348/kjr.2006.7.1.41.

The Balloon Dilatation and Large Profile Catheter Maintenance Method for the Management of the Bile Duct Stricture Following Liver Transplantation

Affiliations
  • 1Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. swshin @smc.samsung.co.kr
  • 2Department of Radiology, Sung-Ae General Hospital, Seoul, Korea.

Abstract


OBJECTIVE
We wanted to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and large profile catheter maintenance method for the management of patients with anastomotic biliary strictures following liver transplant. MATERIALS AND METHODS: From May 1999 to June 2003, 12 patients with symptomatic benign biliary stricture complicated by liver transplantation were treated with the percutaneous balloon dilatation and large profile catheter maintenance method (1-6 months). The patients were eight males and four females, and their ages ranged from 20 to 62 years (mean age: 44 years). Ten patients underwent living donor liver transplantation and two underwent cadaveric liver transplantation. Postoperative biliary strictures occurred from two to 21 months (mean age: 18 months) after liver transplantation. RESULTS: The initial technical success rate was 92%. Patency of the bile duct was preserved for eight to 40 months (mean period: 19 months) in 10 of 12 (84%) patients. When reviewing two patients (17%), secondary balloon dilatations were needed for treating the delayed recurrence of biliary stricture. In one patient, no recurrent stenosis was seen during the further 10 months follow-up after secondary balloon dilatation. Another patient did not response to secondary balloon dilatation, and he was treated by surgery. Eleven of 12 patients (92%) showed good biliary patency for 8-40 months (mean period: 19 months) of follow-up. CONCLUSION: The percutaneous balloon dilatation and large profile catheter maintenance method is an effective therapeutic alternative for the treatment of most biliary strictures that complicate liver transplantation. It has a high success rate and it should be considered before surgery.

Keyword

Liver; Bile ducts; Bile ducts abnormalities; Intervention

MeSH Terms

Treatment Outcome
Middle Aged
Male
Liver Transplantation/*adverse effects
Humans
Hepatic Artery/ultrasonography
Female
Constriction, Pathologic/etiology/therapy
Cholangiography
Bile Duct Diseases/etiology/*therapy
Balloon Dilatation/*methods
Adult

Figure

  • Fig. 1 A 57-year-old male with choledocho-choledochostomy after living donor liver transplantation. A. The cholangiography obtained after transhepatic insertion of a biliary drainage catheter shows a biliary anastomotic stricture, which divided the fifth and eighth segment ducts from the sixth and seventh segment ducts (white and black arrow). B. An 8 mm diameter balloon catheter was positioned through the anastomotic stricture. C. Two internal-external biliary drainage catheters (12 and 14 F) were inserted after biloplasty. D. The cholangiogram after the large profile catheter maintenance method (3 months) shows patent bile ducts (arrow), with excellent flow of contrast medium into the duodenal loop.

  • Fig. 2 A 56-year-old man with choledocho-choledochostomy after living donor liver transplantation. A. The cholangiography obtained during transhepatic insertion of a biliary drainage catheter shows a biliary anastomotic stricture (arrow). B. An 8 mm diameter balloon catheters was positioned through the anastomotic stricture. C. A percutaneous transhepatic cholangiographic catheter (16 F) was inserted after biloplasty. D. The cholangiogram after the large profile catheter maintenance method (2 months) shows patent bile ducts (arrow), with excellent flow of contrast medium into the duodenal loop.

  • Fig. 3 Flow diagram showing the balloon dilatation and large profile catheter maintenance method following liver transplantation.


Cited by  1 articles

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications
Hyun Woo Lee, Najmul Hassan Shah, Sung Koo Lee
Clin Endosc. 2017;50(5):451-463.    doi: 10.5946/ce.2016.139.


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