Abstract No. 544 Percutaneous cholangiographic and cholangioscopic interventions through Hutson loops: a single-center experience in liver transplant patients

Abstract

Percutaneous transhepatic cholangiography (PTC) interventions are not without risks to the liver transplant (LT) (e.g., bleeding, infection) [1]. An alternative option for biliary access involves surgical affixation of the afferent Roux limb to the anterior abdominal wall, known as the Hutson loop. We present our institutional experience in managing biliary anastomotic pathology via the Hutson loop. With IRB approval, we report 11 cases of percutaneous biliary interventions through Hutson loops for diagnostic/therapeutic benefit. Procedure indications, technical success, complications, and need for subsequent PTC were assessed. Hutson loops were created during living donor LT in 6 and deceased donor LT in 5 patients. Patients had Roux-en-Y choledochojejunostomies (3 patients) or hepaticojejunostomies (single: 6 patients; multiple: 2 patients). The indication was stricture [6 (55%)], anastomotic leak [3 (27%)], and other [2 (18%)]. All procedures were performed with monitored anesthesia care. 4 (36%) patients had diagnostic cholangiograms through the Hutson loop demonstrating no leak/stricture with no subsequent need for PTC/complex ERCP. A stricture was identified in 4 (36%) patients and was managed by cholangioplasty [3 (27%)], stenting [2 (18%)], and/or drainage [3 (27%)]. A leak was identified in 1 (9%) patient and was managed via the Hutson loop with plastic stents. The stents were retrieved by IR (via the Hutson loop) after the leak resolved. The biliary system could not be opacified in 1 (9%) patient necessitating PTC. 0.018” wire PTC access was used to place a retrograde biliary drain (via Hutson loop). Bowel injury occurred in 1 (9%) patient requiring surgical repair. 8 different patients where Hutson loop access was not successful were subsequently managed via the PTC route. Cholangiography/cholangioscopy via the Hutson loop is an effective intervention to address biliary anastomotic pathology in patients with Roux-en-Y. As with any new intervention, there is a learning curve. Our newly established multidisciplinary protocol to address biliary complications in LT patients aims to increase safety/efficacy of these interventions.