title: Double-balloon enteroscopy for bilioenteric anastomotic stricture after pediatric living donor liver transplantation.
abstract: Bilioenteric anastomotic stricture after liver transplantation is still frequent and early detection and treatment is important. We established the management using double-balloon enteroscopy (DBE) and evaluated the intractability for bilioenteric anastomotic stricture after pediatric living donor liver transplantation (LDLT). We underwent DBE at Jichi Medical University from May 2003 to July 2009 for 25 patients who developed bilioenteric anastomotic stricture after pediatric LDLT. The patients were divided into two types according to the degree of dilatation of the anastomotic sites before and after interventional radiology (IVR) using DBE. Type I is an anastomotic site macroscopically dilated to five times or more, and Type II is an anastomotic site dilated to less than five times. The rate of DBE reaching the bilioenteric anastomotic sites was 68.0% (17/25), and the success rate of IVR was 88.2% (15/17). There were three cases of Type I and 12 cases of Type II. Type II had a significantly longer cold ischemic time and higher recurrence rate than Type I (P = 0.005 and P = 0.006). In conclusion, DBE is a less invasive and safe treatment method that is capable of reaching the bilioenteric anastomotic site after pediatric LDLT and enables IVR to be performed on strictures, and its treatment outcomes are improving. Type II and long cold ischemic time are risk factors for intractable bilioenteric anastomotic stricture.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan. yuki371@jichi.ac.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Wataru
authors.initials: W
authors.lastname: Hatanaka
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.forename: Minoru
authors.initials: M
authors.lastname: Umehara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Egami
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.forename: Shuji
authors.initials: S
authors.lastname: Hishikawa
authors.forename: Takehito
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Yasunaru
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hyodo
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Hideo
authors.initials: H
authors.lastname: Kawarasaki
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002648:Child; D050377:Cold Ischemia; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D058582:Double-Balloon Enteroscopy; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D015642:Radiology, Interventional; D012189:Retrospective Studies