Endoscopic treatment of post-liver transplantation biliary leaks with stent placement across the leak site.
BACKGROUND
Biliary tract leaks occur in over 10% of patients undergoing liver transplantation and are the most common cause of biliary tract-related death in these patients. A number of treatment options are available, but a standard approach has not been established.


METHODS
Twenty-six patients were retrospectively studied who had post-transplantation leaks develop with special reference to those who underwent endoscopic placement of a "leak-bridging" stent.


RESULTS
Endoscopic retrograde cholangiography was performed in all cases with no procedure-related complications. Twenty-four patients had a leak-bridging stent, 1 a transpapillary stent, and 1 a nasobiliary drain. Leak resolution occurred in 23 cases (88%) after initial stent placement. The median time to stent removal was 8 weeks. Three patients did not respond to initial treatment; 2 were successfully treated with another stent and a single patient required surgical repair. Four deaths occurred during follow-up, all unrelated to the biliary leak.


CONCLUSIONS
Placement of a leak-bridging stent is a safe and effective initial treatment for post-liver transplantation biliary leaks.
Morelli
J
J
Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas Blvd., Charleston, SC 29425, USA.
Mulcahy
H E
HE
Willner
I R
IR
Baliga
P
P
Chavin
K D
KD
Patel
R
R
Payne
M
M
Cotton
P B
PB
Hawes
R
R
Reuben
A
A
Cunningham
J T
JT
D001646:Bile; D001652:Bile Ducts; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome