Endoscopic management of biliary complications after adult living donor liver transplantation

被引:111
作者
Tsujino, Takeshi
Isayama, Hiroyuki
Sugawara, Yasuhiko
Sasaki, Takashi
Kogure, Hirofumi
Nakai, Yousuke
Yamamoto, Natsuyo
Sasahira, Naoki
Yamashiki, Noriyo
Tada, Minoru
Yoshida, Haruhiko
Kokudo, Norihiro
Kawabe, Takao
Makuuchi, Masatoshi
Omata, Masao
机构
[1] Univ Tokyo, Fac Med, Dept Gastroenterol, Bunkyo Ku, Tokyo 1138655, Japan
[2] Univ Tokyo, Fac Med, Dept Surg, Bunkyo Ku, Tokyo 1138655, Japan
[3] Univ Tokyo, Fac Med, Dept Endoscopy & Endoscop Surg, Bunkyo Ku, Tokyo 1138655, Japan
关键词
D O I
10.1111/j.1572-0241.2006.00797.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
OBJECTIVES: Biliary complications are one of the important issues to be addressed after liver transplantation. Endoscopic management of biliary complications after deceased donor liver transplantation (DDLT) is widely accepted, but it remains to be established in patients after living donor liver transplantation (LDLT). Endoscopic management in LDLT patients is difficult mainly because of the complexity of duct-to-duct reconstruction. METHODS: A total of 174 adult LDLTs with duct-to-duct reconstruction were performed in our institution. Biliary complications developed in 53 patients (30%). Among these, 18 patients were referred for endoscopic management and were the subjects of the present study. Success rate, early morbidity, and outcome were evaluated in these 18 patients. RESULTS: The type of graft was the right liver in six, left liver in eight, and right lateral sector in four patients. Ten out of 18 patients had one biliary anastomosis and the remaining eight had multiple anastomoses. Six patients had a previous history of surgical or percutaneous intervention for biliary complications after LDLT. Seventeen patients had one or more biliary strictures. Biliary casts were found in nine patients, three of whom had concomitant bile leaks. Strictures were successfully treated with endoscopic balloon dilation in 12 (71%) of the 17 patients (nasobiliary catheter placement in eight and stent placement in four patients). Bile leak was successfully managed in two of three patients. Biliary casts were removed by endoscopic papillary balloon dilation in eight of nine patients. Five patients with failed endoscopic therapy were converted to percutaneous or surgical intervention. Endoscopic-procedure-related cholangitis developed in one patient. During follow-up with median periods of 10 months (range 2-20 months), four of nine patients without stent placement developed biliary strictures, and these were relieved by additional endoscopic management. CONCLUSIONS: Endoscopic approach has the potential to be a first-line therapy for the management of biliary complications after LDLT.
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页码:2230 / 2236
页数:7
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