title: Prospective evaluation of single-operator peroral cholangioscopy in liver transplant recipients requiring an evaluation of the biliary tract.
abstract: In this descriptive study, we examined the role of single-operator cholangioscopy (SOC) in the evaluation of biliary complications after liver transplantation (LT). We prospectively included adult recipients of deceased donor LT who were referred for endoscopic retrograde cholangiopancreatography between June 2009 and July 2011. All patients underwent SOC with biopsy of the biliary anastomosis. Sixteen patients were included: 12 with biliary anastomotic strictures (ASs), 2 with common bile duct stones, 1 with a bile leak, and 1 with sphincter of Oddi dysfunction. Patients with ASs displayed 1 of 2 patterns: (A) mild erythema (n = 9) or (B) edema, ulceration, and sloughing (n = 3). Those without ASs displayed a pale mucosa with mild edema at the anastomosis. Patients with ASs and pattern B required a longer period of stenting than patients with pattern A (457 versus 167 days, P = 0.02). In addition, patients with pattern A had a better response and better resolution of their strictures with endoscopic therapy than those with pattern B (66% versus 33%, P = 0.13). Histological examinations of ASs showed nonspecific intraepithelial inflammation in patients with patterns A and B. Biopsy samples from patients without ASs showed normal columnar epithelial bile duct cells. The total cholangioscopy time for all procedures was 26.8 ± 10.1 minutes. In conclusion, SOC in LT recipients is feasible and allows adequate visualization and tissue sampling of ASs and bile ducts. Two distinct visual patterns that are easily identified with SOC may help to predict the outcomes of endoscopic therapy in patients with biliary complications after LT.
authors: Gastrointestinal/Endoscopy Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors: Domingo
authors: D
authors: Balderramo
authors: Oriol
authors: O
authors: Sendino
authors: Rosa
authors: R
authors: Miquel
authors: Cristina Rodriguez
authors: CR
authors: de Miguel
authors: Josep M
authors: JM
authors: Bordas
authors: Graciela
authors: G
authors: Martinez-Palli
authors: Maria L
authors: ML
authors: Leoz
authors: Antoni
authors: A
authors: Rimola
authors: Miguel
authors: M
authors: Navasa
authors: Josep
authors: J
authors: Llach
authors: Andrés
authors: A
authors: Cardenas
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000473:pathology; D001659:Biliary Tract / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D001706:Biopsy; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation; D002779:Cholestasis / Q000209:etiology / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D046628:Sphincter of Oddi Dysfunction / Q000209:etiology / Q000473:pathology; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome