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

• Choo SW
• Shin SW
• Do YS
• Liu WC
• Park KB
• Sung YM
• Choo IW

• KMID: 753915
• DOI: http://doi.org/10.3348/kjr.2006.7.1.41

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

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  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.

Reference

1. Stratta RJ, Wood RP, Langnas AN, Hollins RR, Bruder KJ, Donovan JP, et al. Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation. Surgery. 1989. 106:675–683.

2. Rabkin JM, Orloff SL, Reed MH, Wheeler LJ, Corless CL, Benner KG, et al. Biliary tract complications of side-to-side without T tube versus end-to-end with or without T tube choledochocholedochostomy in liver transplant recipients. Transplantation. 1998. 65:193–199.

3. Thethy S, Thomson B, Pleass H, Wigmore SJ, Madhavan K, Akyol M, et al. Management of biliary tract complications after orthotopic liver transplantation. Clin Transplant. 2004. 18:647–653.

4. Gholson CF, Zibari G, McDonald JC. Endoscopic diagnosis and management of biliary complications following orthotopic liver transplantation. Dig Dis Sci. 1996. 41:1045–1053.

5. Citron SJ, Martin LG. Benign biliary strictures: treatment with percutaneous cholangioplasty. Radiology. 1991. 178:339–341.

6. Mueller PR, Ferrucci JT Jr, Teplick SK, vanSonnenberg E, Haskin PH, Butch RJ, et al. Biliary stent endoprosthesis: analysis of complications in 113 patients. Radiology. 1985. 156:637–639.

7. Klein AS, Savader S, Burdick JF, Fair J, Mitchell M, Colombani P, et al. Reduction of morbidity and mortality from biliary complications after liver transplantation. Hepatology. 1991. 14:818–823.

8. Rossi G, Lucianetti A, Gridelli B, Colledan M, Caccamo L, Albani AP, et al. Biliary tract complications in 224 orthotopic liver transplantations. Transplant Proc. 1994. 26:3626–3628.

9. Jeffrey GP, Brind AM, Ormonde DG, Frazer CK, Ferguson J, Bell R, et al. Management of biliary tract complications following liver transplantation. Aust N Z J Surg. 1999. 69:717–722.

10. Kuo PC, Lewis WD, Stokes K, Pleskow D, Simpson MA, Jenkins RL. A comparison of operation, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography in biliary complications after hepatic transplantation. J Am Coll Surg. 1994. 179:177–181.

11. Ward EM, Kiely MJ, Maus TP, Wiesner RH, Krom RA. Hilar biliary strictures after liver transplantation: cholangiography and percutaneous treatment. Radiology. 1990. 177:259–263.

12. Sheng R, Zajko AB, Campbell WL, Abu-Elmagd K. Biliary strictures in hepatic transplants: prevalence and types in patients with primary sclerosing cholangitis vs those with other liver diseases. AJR Am J Roentgenol. 1993. 161:297–300.

13. Sanchez-Urdazpal L, Gores GJ, Ward EM, Hay E, Buckel EG, Wiesner RH, et al. Clinical outcome of ischemic-type biliary complications after liver transplantation. Transplant Proc. 1993. 25:1107–1109.

14. Vorwerk D, Gunther RW, Klever P, Riesener KP, Schumpelick V. Angioplasty and stent placement for treatment of hepatic artery thrombosis following liver transplantation. J Vasc Interv Radiol. 1994. 5:309–311.

15. Greif F, Bronsther OL, Van Thiel DH, Casavilla A, Iwatsuki S, Tzakis A, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg. 1994. 219:40–45.

16. McDonald ML, Farnell MB, Nagorney DM, Ilstrup DM, Kutch JM. Benign biliary strictures: repair and outcome with a contemporary approach. Surgery. 1995. 118:582–590.

17. Zajko AB, Campbell WL, Bron KM, Lecky JW, Iwatsuki S, Shaw BW Jr, et al. Cholangiography and interventional biliary radiology in adult liver transplantation. AJR Am J Roentgenol. 1985. 144:127–133.

18. Pitt HA, Kaufman SL, Coleman J, White RI, Cameron JL. Benign postoperative biliary strictures. Operate or dilate? Ann Surg. 1989. 210:417–425.

19. Culp WC, McCowan TC, Lieberman RP, Goertzen TC, LeVeen RF, Heffron TG. Biliary strictures in liver transplant recipients: treatment with metal stents. Radiology. 1996. 199:339–346.

20. Diamond NG, Lee SP, Niblett RL, Rees CR, Klintmalm GB. Metallic stents for the treatment of intrahepatic biliary strictures after liver transplantation. J Vasc Interv Radiol. 1995. 6:755–761.

21. Petersen BD, Maxfield SR, Ivancev K, Uchida BT, Rabkin JM, Rosch J. Biliary strictures in hepatic transplantation: treatment with self-expanding Z stents. J Vasc Interv Radiol. 1996. 7:221–228.

22. Bonnel DH, Liguory CL, Lefebvre JF, Cornud FE. Placement of metallic stents for treatment of postoperative biliary strictures: long-term outcome in 25 patients. AJR Am J Roentgenol. 1997. 169:1517–1522.

23. Ferrucci JT Jr, Mueller PR, Harbin WP. Percutaneous transhepatic biliary drainage: technique, results, and applications. Radiology. 1980. 135:1–13.

24. Letourneau JG, Hunter DW, Ascher NL, Roberts JP, Payne WD, Thompson WM, et al. Biliary complications after liver transplantation in children. Radiology. 1989. 170:1095–1099.

25. Jan YY, Chen MF. Percutaneous trans-hepatic cholangioscopic lithotomy for hepatolithiasis: long-term results. Gastrointest Endosc. 1995. 42:1–5.

26. Ponchon T, Genin G, Mitchell R, Henry L, Bory RM, Bodnar D, et al. Methods, indications, and results of percutaneous choledochoscopy. A series of 161 procedures. Ann Surg. 1996. 223:26–36.

27. Hwang MH, Tsai CC, Mo LR, Yang CT, Yeh YH, Yau MP, et al. Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients. Eur J Radiol. 1993. 17:184–190.

28. Jeng KS, Chiang HJ, Shih SC. Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi. World J Surg. 1989. 13:603–610.

29. Bonnel DH, Liguory CE, Cornud FE, Lefebvre JF. Common bile duct and intrahepatic stones: results of transhepatic electrohydraulic lithotripsy in 50 patients. Radiology. 1991. 180:345–348.