Transhepatic balloon dilatation of early biliary strictures in pediatric liver transplantation: successful initial and mid-term outcome.
OBJECTIVE
To evaluate the initial and mid-term outcomes of transhepatic balloon dilatation for the treatment of early biliary strictures in lateral left-segment liver transplants in young children.


METHODS
Between April 1997 and May 2001, seven children aged 9 months to 6 years with nine benign strictures in left-segment liver grafts were treated percutaneously. Sessions of two or three dilations were performed three or four times at average intervals of 10-20 days. In each session, the biliary stenoses were gradually dilated using balloons of 3-7 mm. Follow-up ranged from 12 to 54 months (mean 27 months, median 12 months). Clinical success was defined as resolution of the stenosis, normalization of liver enzymes and lack of clinical symptoms


RESULTS
Technical success was achieved in all nine strictures. Hemobilia occurred in one patient and was successfully treated. On follow-up, all patients had complete clinical recovery with normalization of liver function and imaging of patent bile ducts.


CONCLUSIONS
Balloon dilatation is an effective and relatively safe method for the treatment of early biliary strictures in left-segment liver transplantation in young children. We recommend this approach as the initial treatment for early strictures. Metal stents or surgery should be reserved for patients with late appearance of strictures or failure of balloon dilatation.
Belenky
Alexander
A
Department of Radiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel.
Mor
Eytan
E
Bartal
Gabriel
G
Atar
Eli
E
Shapiro
Riki
R
Bar-Nathan
Nathan
N
Bachar
Gil N
GN
D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000473:pathology; D001660:Biliary Tract Diseases / Q000628:therapy*; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome