PATIENTS WITH POST TRANSPLANT BILIARY STRICTURES HAVE SIGNIFICANTLY HIGHER RATES OF LIVER TRANSPLANT FAILURE AND REJECTION: A NATIONWIDE INPATIENT ANALYSIS

We report a case of a post-transplant patient with hepaticojejunostomy in whom we used a single balloon enteroscopy to access the biliary tree. This procedure seems to be safe and feasible for approaching the biliary anastomosis by means of the overtube and fixation of the small bowel by the balloon.

Download Full-text

Cholangioscopy-guided steroid injection for refractory post liver transplant anastomotic strictures: a rescue case series

Therapeutic Advances in Gastrointestinal Endoscopy ◽

10.1177/2631774519867786 ◽

2019 ◽

Vol 12 ◽

pp. 263177451986778 ◽

Cited By ~ 2

Author(s):

Tomazo Franzini ◽

Vitor M.T. Sagae ◽

Hugo G. Guedes ◽

Paulo Sakai ◽

Daniel R. Waisberg ◽

...

Keyword(s):

Liver Transplant ◽

Steroid Injection ◽

Revisional Surgery ◽

Balloon Dilation ◽

Metallic Stents ◽

Plastic Stents ◽

Biliary Strictures ◽

Anastomotic Strictures ◽

Expandable Metallic Stents

Background and aims: Post liver transplant biliary anastomotic strictures have traditionally been treated with balloon dilation and multiple plastic stents. Fully covered self-expandable metallic stents may be used as an initial alternative or after multiple plastic stents failure. Refractory strictures can occur in 10–22% and require revisional surgery. Alternatively, cholangioscopy allows direct visualization and therapeutic approaches. We aimed to assess the feasibility, safety, and efficacy of balloon dilation combined with cholangioscopy-guided steroid injection for the treatment of refractory anastomotic biliary strictures. Methods: Three post-orthotopic liver transplant patients who failed standard treatment of their biliary anastomotic strictures underwent endoscopic retrograde cholangiopancreatography with balloon dilation followed by cholangioscopy-guided steroid injection at a tertiary care center. Patients had follow-up with images and laboratorial tests to evaluate for residual stricture. Results: Technical success of balloon dilation + cholangioscopy-guided steroid injection was achieved in all patients. Cholangioscopy permitted accurate evaluation of bile ducts and precise localization for steroid injection. No adverse events occurred. Mean follow-up was 26 months. Two patients are stent free and remain well in follow-up, with no signs of biliary obstruction. No further therapeutic endoscopic procedures or revisional surgery were required. One patient did not respond to balloon dilation + cholangioscopy-guided steroid injection after 11 months of follow-up and required repeat balloon dilation of new strictures above the anastomosis. Conclusion: Cholangioscopy-guided steroid injection combined with balloon dilation in the treatment of refractory post liver transplant strictures is feasible and safe. This method may be used as a rescue alternative before surgical approach. Randomized controlled trials comparing balloon dilation + cholangioscopy-guided steroid injection to fully covered self-expandable metallic stents are needed to determine the role of this treatment for anastomotic biliary strictures.

Download Full-text