Application of SpyGlass peroral choledochoscopy to the diagnosis and treatment of biliary stricture after liver transplantation
10.3760/cma.j.cn321463-20211109-00612
- VernacularTitle:SpyGlass经口胆道镜在肝移植术后胆道狭窄诊治中的应用
- Author:
Yu LI
1
;
Jie HAO
;
Xuemin LIU
;
Bo WANG
;
Yi LYU
;
Hao SUN
Author Information
1. 西安交通大学第一附属医院肝胆外科，西安 710061
- Keywords:
Liver transplantation;
Peroral choledochoscopy;
Biliary stricture;
Selective guidewire placement
- From:
Chinese Journal of Digestive Endoscopy
2022;39(12):998-1003
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the characteristics of biliary stricture after liver transplantation (LT) under SpyGlass peroral choledochoscopy and to investigate its treatment value for difficult stricture.Method:A total of 24 patients of biliary stricture after LT at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University underwent SpyGlass examination from January 2019 to December 2020, 15.5 months (2-58 months) after surgery. The characteristics of different types of strictures and the selective guidewire placement results by SpyGlass were recorded and analyzed.Results:Of the 24 patients, 9 were anastomostic strictures (AS) and 15 others were non-anastomostic strictures (NAS). The main characteristic of 5 initial AS patients was scar constriction. Whether treated or not, all of the 15 NAS patients showed evident inflammatory hyperplasia in hilar bile duct under SpyGlass, 80% (12/15) of which were accompanied with intrahepatic biliary stones. The strictures disappeared with mild hyperplasia in 8 patients (4 AS and 4 NAS) whose biliary stents were extracted. Eleven patients (5 AS and 6 NAS) needed guidwire placement under SpyGlass, six (54.5%) of whom succeeded. The successful rate in AS patients was higher than that of NAS (4/5 VS 2/6).Conclusion:The main characteristic of AS is scar constriction and that of NAS is inflammatory hyperplasia. Selective guidewire placement can be achieved by SpyGlass peroral choledochoscopy with a satisfactory successful rate in the difficult AS.
