Percutaneous treatment of biliary cast syndrome after orthotopic liver transplantation: comparison of mechanical versus hydraulic rheolytic cast extraction.
OBJECTIVE
Biliary cast syndrome (BCS) is the presence of casts within the intrahepatic or extrahepatic biliary system after orthotopic liver transplantation. Our work compares two percutaneous methods for BCS treatment: the mechanical cast-extraction technique (MCE) versus the hydraulic cast-extraction (HCE) technique using a rheolytic system.


METHODS
A total of 24 patients were included in the study. Six patients were referred for HCE, and 18 patients were treated with MCE. A statistically significant larger number of sessions was required in the MCE group (21.0, range 11 to 72 sessions) (p = 0.033).


RESULTS
Median therapy duration was shorter in the HCE group at 2.4 months (range 2 to 5) compared with 6.7 months (range 3 to 39) in the MCE group (p < 0.001). Both patient acceptance was better and costs for total therapy were 40% less in the HCE group. No significant differences where found concerning clinical and biochemical improvement or graft and patient survival.


CONCLUSIONS
The use of the hydraulic rheolytic system decreased total therapy time, thereby decreasing the induced inflammation time of the biliary tree. A significant benefit of HCE has been observed in our patients when we compare our results with those of MCE.
Department of Diagnostic Radiology, University of Heidelberg, Heidelberg, Germany. ruben.lopez@med.uni-heidelberg.de
R
R
López-Benítez
M O
MO
Wielpütz
M G H
MG
Bryant
Tom
T
Ganten
G M
GM
Richter
N
N
Flach
P J
PJ
Hallscheidt
D000368:Aged; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002404:Catheterization; D002758:Cholangiography; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015641:Radiography, Interventional