An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications.
- Author:
Hyun Woo LEE
1
;
Najmul Hassan SHAH
;
Sung Koo LEE
Author Information
- Publication Type:Review
- Keywords: Liver transplantation; Biliary tract diseases; Choledocholithiasis; Anastomotic leak; Cholangiopancreatography, endoscopic retrograde
- MeSH: Anastomotic Leak; Bile; Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde; Choledocholithiasis; Constriction, Pathologic; Foreign Bodies; Hemobilia; Humans; Incidence; Liver Transplantation; Methods; Stents
- From:Clinical Endoscopy 2017;50(5):451-463
- CountryRepublic of Korea
- Language:English
- Abstract: Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.
