Endoscopic therapy of posttransplant biliary stenoses after right-sided adult living donor liver transplantation.
OBJECTIVE
Endoscopic treatment of biliary strictures after liver transplantation is a therapeutic challenge. In particular, outcomes of endoscopic therapy of biliary complications in the case of duct-to-duct anastomosis after living related liver transplantation are limited. The aim of this study was to evaluate the feasibility and success of an endoscopic treatment approach to posttransplant biliary strictures (PTBS) after right-sided living donor liver transplantation (RLDLT) with duct-to-duct anastomosis.


METHODS
Ninety patients who received adult-to-adult RLDLT in our center were screened retrospectively with respect to endoscopic treatment of PTBS. Therapy was judged as successful when cholestasis parameters returned to normal and bile duct narrowing was reduced significantly after the completion of therapy.


RESULTS
Forty of 90 RLDLT patients received duct-to-duct anastomosis, 12 (30%) showed PTBS. Seven of 12 patients were treated successfully by endoscopy; the remaining 5 patients were treated primarily by surgery. Most patients were treated by balloon dilatation followed by insertion of endoprostheses. A median of 2.5 dilatation sessions were necessary and the median treatment duration was 8 months. One patient developed endoscopy-treatable recurrent stenosis, no surgical intervention was necessary. Mild pancreatitis occurred in 7.9% and cholangitis in 5.3% of the procedures. One minor bleeding episode occurred during sphincterotomy. Bleeding was managed endoscopically.


CONCLUSIONS
Endoscopic therapy of adult-to-adult right living related liver transplantation with duct-to-duct anastomosis is feasible and frequently is successful. The duct-to-duct anastomosis offers the possibility of endoscopic treatment. Endoscopic treatment of posttransplant biliary strictures is safe, with a low specific complication rate.
Zoepf
Thomas
T
Department of Gastroenterology and Hepatology, University Hospital of Essen, Hufelandstrasse 55, D-45147 Essen, Germany. thomas.zoepf@uni-essen.de
Maldonado-Lopez
Evelyn J
EJ
Hilgard
Philip
P
Schlaak
Joerg
J
Malago
Massimo
M
Broelsch
Christoph E
CE
Treichel
Ulrich
U
Gerken
Guido
G
D002404:Catheterization; D002779:Cholestasis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D016145:Endoscopy, Digestive System; D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012189:Retrospective Studies; D016896:Treatment Outcome