Abstract
Endoscopic management is the mainstay for biliary strictures after liver transplantation. However, this method is often failed in cases associated with hepatolithiasis or refractory strictures. The aim of this study is to investigate whether 1-step percutaneous transhepatic biliary cholangiography (PTC) combined with high-frequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management. Clinical data of 14 patients suffering from biliary strictures after liver transplantation from June 2014 to January 2018 were retrospectively analyzed. One-step PTC combined with high-frequency needle-knife electrotomy was used to resolve the strictures. One-step PTC was successfully performed in all 14 patients. In 10 of 12 (83.3%) patients with hepatolithiasis, the stones were removed completely. Stricture resolution was detected in 13 of 14 (92.9%) patients at first postoperative choledochoscopy. Three mild adverse events occurred (cholangitis, 2 patients; delayed hemobilia, 1 patient), but were resolved with conservative treatment. The follow-up after supporting catheter removal was 15.7±4.5 months. Only 1 patient (8.3%) had stone recurrence and no stenosis occurred during supporting-catheter-free follow-up. One-step PTC combined with high-frequency needle-knife electrotomy seems to be a useful for treating biliary strictures after liver transplantation.
Highlights
Orthotopic liver transplantation (OLT) is the main treatment for patients with end-stage liver disease of different etiologies, hepatocellular carcinoma(HCC), and acute liver failure[1,2] Biliary strictures represent the most frequent biliary complication after liver transplantation, accounting for approximately 40% of all biliary complications [3,4,5]
The aim of this study is to investigate whether one-step PTC combined with highfrequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management
One-step PTC was successfully performed in all 14 patients
Summary
Orthotopic liver transplantation (OLT) is the main treatment for patients with end-stage liver disease of different etiologies, hepatocellular carcinoma(HCC), and acute liver failure[1,2] Biliary strictures represent the most frequent biliary complication after liver transplantation, accounting for approximately 40% of all biliary complications [3,4,5]. Some refractory strictures, such as “tubular stricture” characterized as a columnar stenosis of bile duct more than 5 mm, are often failed in balloon dilatation and stent placement [11]. These cases are even hard to tackle by traditional percutaneous transhepatic biliary drainage (PTCD), which use balloon or basket to treat strictures and stones under the guidance of cholangiography [6]. Endoscopic management is the mainstay for biliary strictures after liver transplantation This method is often failed in cases associated with hepatolithiasis or refractory strictures. The aim of this study is to investigate whether one-step PTC combined with highfrequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management
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