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• W2029959851 abstract "Background & Aims: Endoscopic treatment of biliary strictures after liver transplantation is a therapeutic challenge. In particular, outcomes of endoscopic therapy of biliary complications in the case of duct-to-duct anastomosis after living related liver transplantation are limited. The aim of this study was to evaluate the feasibility and success of an endoscopic treatment approach to posttransplant biliary strictures (PTBS) after right-sided living donor liver transplantation (RLDLT) with duct-to-duct anastomosis. Methods: Ninety patients who received adult-to-adult RLDLT in our center were screened retrospectively with respect to endoscopic treatment of PTBS. Therapy was judged as successful when cholestasis parameters returned to normal and bile duct narrowing was reduced significantly after the completion of therapy. Results: Forty of 90 RLDLT patients received duct-to-duct anastomosis, 12 (30%) showed PTBS. Seven of 12 patients were treated successfully by endoscopy; the remaining 5 patients were treated primarily by surgery. Most patients were treated by balloon dilatation followed by insertion of endoprostheses. A median of 2.5 dilatation sessions were necessary and the median treatment duration was 8 months. One patient developed endoscopy-treatable recurrent stenosis, no surgical intervention was necessary. Mild pancreatitis occurred in 7.9% and cholangitis in 5.3% of the procedures. One minor bleeding episode occurred during sphincterotomy. Bleeding was managed endoscopically. Conclusions: Endoscopic therapy of adult-to-adult right living related liver transplantation with duct-to-duct anastomosis is feasible and frequently is successful. The duct-to-duct anastomosis offers the possibility of endoscopic treatment. Endoscopic treatment of posttransplant biliary strictures is safe, with a low specific complication rate. Background & Aims: Endoscopic treatment of biliary strictures after liver transplantation is a therapeutic challenge. In particular, outcomes of endoscopic therapy of biliary complications in the case of duct-to-duct anastomosis after living related liver transplantation are limited. The aim of this study was to evaluate the feasibility and success of an endoscopic treatment approach to posttransplant biliary strictures (PTBS) after right-sided living donor liver transplantation (RLDLT) with duct-to-duct anastomosis. Methods: Ninety patients who received adult-to-adult RLDLT in our center were screened retrospectively with respect to endoscopic treatment of PTBS. Therapy was judged as successful when cholestasis parameters returned to normal and bile duct narrowing was reduced significantly after the completion of therapy. Results: Forty of 90 RLDLT patients received duct-to-duct anastomosis, 12 (30%) showed PTBS. Seven of 12 patients were treated successfully by endoscopy; the remaining 5 patients were treated primarily by surgery. Most patients were treated by balloon dilatation followed by insertion of endoprostheses. A median of 2.5 dilatation sessions were necessary and the median treatment duration was 8 months. One patient developed endoscopy-treatable recurrent stenosis, no surgical intervention was necessary. Mild pancreatitis occurred in 7.9% and cholangitis in 5.3% of the procedures. One minor bleeding episode occurred during sphincterotomy. Bleeding was managed endoscopically. Conclusions: Endoscopic therapy of adult-to-adult right living related liver transplantation with duct-to-duct anastomosis is feasible and frequently is successful. The duct-to-duct anastomosis offers the possibility of endoscopic treatment. Endoscopic treatment of posttransplant biliary strictures is safe, with a low specific complication rate. Adult-to-adult right living donor liver transplantation (RLDLT) is used increasingly because of a persistent shortage of cadaveric organs for orthotopic liver transplantation.1Broelsch C.E. Malago M. Testa G. et al.Living donor liver transplantation in adults outcome in Europe.Liver Transpl Surg. 2000; 6: 64-65Crossref Scopus (179) Google Scholar The adaption and reconstruction of the bile ducts and the technique of biliary anastomosis in RLDLT is a critical aspect of the procedure. The prevalence of biliary complications in LDLT is higher than in orthotopic liver transplantation, with a frequency of up to 40%.1Broelsch C.E. Malago M. Testa G. et al.Living donor liver transplantation in adults outcome in Europe.Liver Transpl Surg. 2000; 6: 64-65Crossref Scopus (179) Google Scholar, 2Marcos A. Ham J.M. Fisher R.A. et al.Single center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe.Liver Transpl Surg. 2000; 6: 296-301Crossref Scopus (261) Google Scholar Biliary complications are a common cause of graft malfunction and are related to a great proportion of posttransplant recipient mortality.3Testa G. Malago M. Broelsch C.E. Complications of biliary tract in liver transplantation.World J Surg. 2001; 25: 1296-1299Crossref PubMed Scopus (95) Google Scholar The high incidence of stenoses and leaks of the biliary anastomosis in right liver grafting seems to be caused by poorer vascularization of the isolated right biliary tree.4Malago M. Testa G. Hertl M. et al.Biliary reconstruction following right adult living donor liver transplantation end-to-end or end-to-side duct-to-duct anastomosis.Langenbecks Arch Surg. 2002; 387: 37-44Crossref PubMed Scopus (38) Google Scholar In most centers, anastomoses in RLDLT are fashioned as a cholangiojejunostomy for drainage of more than 1 duct. Potential advantages of a duct-to-duct anastomosis are a more physiologic reconstruction, the avoidance of bowel manipulation, a shorter duration of surgical intervention, and easy access and imaging via endoscopic retrograde cholangiography (ERC) both in the early and especially in the late postoperative period, with the possibility of endoscopic management of bile duct complications. Potential disadvantages are a more laborious dissection of the recipient bile duct and some technical difficulty in accommodating size-mismatched bile ducts, which is specific to the end-to-end technique. Recently our group described the feasibility of duct-to-duct anastomoses independent of the presence of 1 or more graft bile ducts.4Malago M. Testa G. Hertl M. et al.Biliary reconstruction following right adult living donor liver transplantation end-to-end or end-to-side duct-to-duct anastomosis.Langenbecks Arch Surg. 2002; 387: 37-44Crossref PubMed Scopus (38) Google Scholar Despite several reports of successful endoscopic therapy of PTBS after orthotopic liver transplantation in small patient series, this therapy option remains controversial.5Vallera R.A. Cotton P.B. Clavien P.A. Biliary reconstruction for liver transplantation and management of biliary complications overview and survey of current practice in the United States.Liver Transplant Surg. 1995; 1: 143-152Crossref PubMed Scopus (86) Google Scholar, 6Gholson C. Zibari G. McDonald J.C. Endoscopic diagnosis and management of biliary complications following orthotopic liver transplantation.Dig Dis Sci. 1996; 41: 1045-1053Crossref PubMed Scopus (51) Google Scholar, 7Greif F. Bronsther O.L. Van Thiel D.H. et al.The incidence, timing and management of biliary tract complications after orthotopic liver transplantation.Ann Surg. 1994; 219: 40-45Crossref PubMed Scopus (416) Google Scholar, 8Sossenheimer M. Slivka A. Carr-Locke D. Management of extrahepatic biliary disease after orthotopic liver transplantation review of the literature and results of a multicenter survey.Endoscopy. 1996; 28: 565-571Crossref PubMed Scopus (43) Google Scholar, 9Hintze R.E. Abou-Rebyeh H. Adler A. et al.Endoscopic therapy of ischemic type biliary lesions (ITBL) in patients after orthotopic liver transplantation.Z Gastroenterol. 1999; 37: 13-20PubMed Google Scholar, 10Hintze R.E. Adler A. Veltzke W. et al.Endoscopic management of biliary complications after orthotopic liver transplantation.Hepatogastroenterology. 1997; 44: 258-262PubMed Google Scholar, 11Rerknimitr R. Sherman S. Fogel E.L. et al.Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis endoscopic findings and results of therapy.Gastrointest Endosc. 2002; 55: 224-231Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar, 12Thuluvath P.J. Atassi T. Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation.Liver Int. 2003; 23: 156-162Crossref PubMed Scopus (154) Google Scholar, 13Morelli J. Mulcahy H.E. Willner I.R. et al.Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement.Gastrointest Endosc. 2003; 58: 374-379Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar, 14Pfau P.R. Kochman M.L. Lewis J.D. et al.Endoscopic management of postoperative biliary complications in orthotopic liver transplantation.Gastrointest Endosc. 2000; 52: 55-63Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar, 15Mosca S. Militerno G. Guardascione M.A. et al.Late biliary tract complications after orthotopic liver transplantation diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography.J Gastroenterol Hepatol. 2000; 15: 654-660Crossref PubMed Scopus (46) Google Scholar, 16Park J.S. Kim M.H. Lee S.K. et al.Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation.Gastrointest Endosc. 2003; 57: 78-85Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar Success rates of endoscopic therapy of PTBS are reported as 27%–100%. In a recent study, endoscopic/radiologic therapy of 16 patients after LDLT with PTBS achieved a success rate of around 67%. Most of them were treated by percutaneous transhepatic cholangiography.16Park J.S. Kim M.H. Lee S.K. et al.Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation.Gastrointest Endosc. 2003; 57: 78-85Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar Experience in transpapillary endoscopic therapy after RLDLT is limited. Therefore, the aim of our study was to evaluate the effectiveness of endoscopic therapy of biliary strictures after RLDLT. Ninety patients receiving RLDLT between August 1998 and September 2003 were analyzed for the presence of bile duct strictures. In all patients, liver biopsy specimens were obtained before ERC to exclude graft rejection, recurrent hepatitis C infection, or chronic graft pathology. Biochemical cholestasis parameters such as serum bilirubin levels, alkaline phosphatase levels, and γ-glutamyl transferase levels were noted at the time of indication for ERC. Biochemical cholestasis parameters and ERC reports were entered into a computer database (Access 2000, Microsoft Duetschland, GmbH, Unterschleissheim, Germany) for analysis. With respect to the results of the ERC, patients were divided into 2 groups: group A with anastomotic stricture; and group B with non-anastomotic strictures of the biliary tract classified as ischemic-type biliary lesions (ITBLs). Depending on the localization of the stenoses, ITBL was subdivided further into 3 groups according to Hintze et al9Hintze R.E. Abou-Rebyeh H. Adler A. et al.Endoscopic therapy of ischemic type biliary lesions (ITBL) in patients after orthotopic liver transplantation.Z Gastroenterol. 1999; 37: 13-20PubMed Google Scholar: type I, extrahepatic lesions; type II, intrahepatic lesions; type III, extrahepatic and intrahepatic lesions. Before endoscopic therapy an endoscopic sphincterotomy was performed. Endoscopic therapy consisted either of balloon dilatation (6-mm MaxForce Balloon; Boston Scientific, Ratingen, Germany) or balloon dilatation combined with the insertion of plastic endoprostheses of an appropriate diameter (7F, 10F, 11.5F Flexima endoprostheses; Boston Scientific) and increasing the diameter size and number when possible. Ischemic-type biliary lesions were treated solely by balloon dilatation (Figure 1, Figure 2).Figure 2Endoscopic therapy of an ischemic-type biliary lesion. (A) Ischemic-type biliary lesion before treatment (black arrow). Cast formation proximal to the stricture (white arrows). (B) Cast extraction. (C) Balloon dilatation of the stricture. (D) After completion of therapy.View Large Image Figure ViewerDownload (PPT) Endoscopic therapy was judged as successful when the bilirubin level decreased to a value of 1.5 mg/dL or less and/or there was radiomorphologic resolution of the stricture after completion of the therapy and without inserted endoprostheses. During further follow-up evaluation, patients presented routinely every 2 months in our interdisciplinary transplantation ambulance where abdominal ultrasound and liver function tests were performed. Statistical analysis was performed with SPSS for Windows release 11.0.1 (SPSS Inc., Chicago, IL). For statistical analysis of paired continuous variables we used the Wilcoxon test; for unpaired continuous variables we used the Mann–Whitney test. To compare unpaired distinct variables a cross-table with a χ2 test was used. The Pearson correlation procedure also was used. The significance level was a P value of .05 or less. Of the 90 patients receiving adult RLDLT between August 1998 and September 2003 there were 40 duct-to-duct biliary anastomoses performed. Seven of the 50 (15%) patients who received hepaticojejunostomy developed PTBS. All of them underwent relaparotomy, and re-hepaticojejunostomy was required in most cases. Twelve of the 40 patients (30%) with duct-to-duct anastomosis developed PTBS. Five of these patients were treated primarily by surgery, based on the judgment of our surgeons, without receiving ERC. The remaining 7 patients received endoscopic therapy of their strictures. The median age of patients with strictures was 55 years (range, 45–65 y) compared with 53.5 years (range, 12–65 y) without strictures (P = .61). In the stricture group, 4 were women and 8 were men compared with 10 women and 18 men in the nonstricture group (P = .591). In the stricture group 3 of 12 (25%) grafts were stored in University of Wisconsin solution and 9 of 12 (75%) grafts were stored in histidine-tryptophan-ketoglutarate solution compared with 10 of 28 (35.7%) stored in University of Wisconsin solution and 18 of 28 (64.3%) stored in histidine-tryptophan-ketoglutarate in the nonstricture group (P = .716) for organ preservation before transplantation. Median cold ischemic time in the stricture group was 209 minutes (range, 124–265 min) compared with 204 minutes (range, 59–403 min) in the nonstricture group (P = .948). However, there was a significant difference in median warm ischemic time between both groups with 48 minutes (range, 30–76 min) for the nonstricture and 56 minutes (range, 37–76 min) for the stricture group (P = .019).17Testa G. Malago M. Nadalin S. et al.Histidine-tryptophan-ketoglutarate versus University of Wisconsin solution in living donor liver transplantation results of a prospective study.Liver Transpl. 2003; 9: 822-826Crossref PubMed Scopus (58) Google Scholar, 18Guichelaar M.M. Benson J.T. Malinchoc M. et al.Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation.Am J Transplant. 2003; 3: 885-890Crossref PubMed Scopus (227) Google Scholar, 19Sankary H.N. McChesney L. Hart M. et al.Identification of donor and recipient risk factors associated with nonanastomotic biliary strictures in human hepatic allografts.Transplant Proc. 1993; 25: 1964-1967PubMed Google Scholar The Pearson correlation model showed a significant correlation between warm ischemic time and PTBS (correlation coefficient [r], .372; significance [P], .025). ERC showed anastomotic stricture in 5 of 7 and ITBL showed anatomic stricture in 2 of 7 patients (1 patient had ITBL type III and 1 patient had ITBL type I). The median time interval between liver transplantation and first ERC was 4 months (range, 1–10 mo) (Table 1).Table 1Results of Endoscopic TherapyMale/female5/2Median age, y (range)57 (45–66)End-to-end anastomosis7/8End-to-side anastomosis1/8Anastomotic strictures5/7Ischemic-type biliary lesions2/7Median interval between RLDLT and endoscopy, mo (range)4 (1–10)Median number of endoscopic interventions needed (range)3.5 (1–11)Balloon dilatation followed by endoprostheses4/7Sole balloon dilatation2/7Sole endoprosthetic therapy1/7Overall success rate7/7Decrease of median bilirubin levels (mg/dL)3.25–1.05P = .012Decrease of median alkaline phosphatase levels (μ/L)307–167P = .05Decrease of median γ-glutamyltransferase levels (μ/L)146.5–94.5P = .263Median follow-up period after endoscopic therapy, mo (range)9.5 (1–36) Open table in a new tab All fashioned duct-to-duct anastomoses could be visualized by ERC. The 7 patients received a total of 38 ERC procedures; the median was 3.5 procedures per patient (range, 1–11 procedures). The median time interval between the procedures was 8 weeks (range, 1–32 wk). All patients received standard sphincterotomy via guidewire before endoscopic treatment. Five of 8 patients were treated with balloon dilatation followed by insertion of endoprostheses. Two patients received isolated balloon dilatation and 1 patient received isolated endoprosthetic treatment. A median of 2.5 balloon dilatations (range, 0–6) were performed per patient. We administered a median of 2.5 endoprostheses (range, 3–19) per patient, which provided each patient with two (double-sided) endoprotheses in 17 treatment sessions. The median maximum total endoprosthetic diameter was 14F (range, 7–21.5F) and the median endoscopic treatment duration was 8 months (range, 2–26 mo). During 5 of 38 treatment sessions the extraction of bile duct stones and/or bile duct sequester (cast) was necessary. Endoscopic therapy was successful in all 7 patients. None of the primarily endoscopically treated patients required surgical therapy of the strictures. The median serum bilirubin level decreased from 3.25 mg/dL (range, 1.5–7.3 mg/dL) to 1.05 mg/dL (range, .5–1.4 mg/dL) (P = .012) after the completion of endoscopic therapy. The median alkaline phosphatase level decreased from 307 U/L (range, 79–444 U/L) to 167 U/L (range, 83–234 U/L) (P = .049). The change in γ-glutamyl transferase levels were not statistically significant (Table 1). Bleeding occurred in 1 of 7 sphincterotomies (14%), which was managed endoscopically by epinephrine injection therapy. Mild bacterial cholangitis, defined as purulent bile during ERC and/or increased C-reactive protein levels in combination with increased cholestasis parameters, occurred twice (5.3%). Mild pancreatitis, defined as increased amylase levels to more than 3 times greater than normal in combination with abdominal pain, was seen in 3 procedures (7.9%). One patient developed recurrence of anastomotic stricture 10 months after endoscopic therapy. In this case, the duration of the initial therapy was only 2 months and therefore relatively short. The recurrent stricture was treated successfully by ERC. One patient received surgical revision of his portal vein because of suspected portal vein thrombosis. The median follow-up evaluation after conclusion of endoscopic therapy is 9.5 months (range, 1–36 mo). Because of a lack of cadaveric organs, LDLT is performed increasingly. RLDLT was introduced in the early 1990s and was suggested to be associated with higher complication rates.1Broelsch C.E. Malago M. Testa G. et al.Living donor liver transplantation in adults outcome in Europe.Liver Transpl Surg. 2000; 6: 64-65Crossref Scopus (179) Google Scholar, 2Marcos A. Ham J.M. Fisher R.A. et al.Single center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe.Liver Transpl Surg. 2000; 6: 296-301Crossref Scopus (261) Google Scholar, 3Testa G. Malago M. Broelsch C.E. Complications of biliary tract in liver transplantation.World J Surg. 2001; 25: 1296-1299Crossref PubMed Scopus (95) Google Scholar, 4Malago M. Testa G. Hertl M. et al.Biliary reconstruction following right adult living donor liver transplantation end-to-end or end-to-side duct-to-duct anastomosis.Langenbecks Arch Surg. 2002; 387: 37-44Crossref PubMed Scopus (38) Google Scholar Although most surgeons still favor a hepaticojejunostomy via Roux-en-Y anastomosis, there is an ongoing trend toward biliary reconstruction in RLDLT.4Malago M. Testa G. Hertl M. et al.Biliary reconstruction following right adult living donor liver transplantation end-to-end or end-to-side duct-to-duct anastomosis.Langenbecks Arch Surg. 2002; 387: 37-44Crossref PubMed Scopus (38) Google Scholar The duct-to-duct anastomosis has several advantages: performing the duct-to-duct reconstruction is more physiologic, bowel manipulation is avoided, surgery is quicker, and, most importantly, there is easy access via ERC in the early and, in particular, in the late postoperative period, with the chance of endoscopic therapy of biliary complications. Despite several reports on successful endoscopic therapy of biliary strictures after orthotopic liver transplantation, endoscopic therapy for this indication remains controversial. In a recent survey only half of the transplantation centers said they perform endoscopic therapy of posttransplant biliary strictures.5Vallera R.A. Cotton P.B. Clavien P.A. Biliary reconstruction for liver transplantation and management of biliary complications overview and survey of current practice in the United States.Liver Transplant Surg. 1995; 1: 143-152Crossref PubMed Scopus (86) Google Scholar Success rates of endoscopic therapy of posttransplant anastomotic strictures have been reported to be between 27% and 100%. In ischemic-type biliary lesions, for which the availability of reliable data are even more limited, success rates of endoscopic treatment as high as 58% to 80% have been reported.5Vallera R.A. Cotton P.B. Clavien P.A. Biliary reconstruction for liver transplantation and management of biliary complications overview and survey of current practice in the United States.Liver Transplant Surg. 1995; 1: 143-152Crossref PubMed Scopus (86) Google Scholar, 6Gholson C. Zibari G. McDonald J.C. Endoscopic diagnosis and management of biliary complications following orthotopic liver transplantation.Dig Dis Sci. 1996; 41: 1045-1053Crossref PubMed Scopus (51) Google Scholar, 7Greif F. Bronsther O.L. Van Thiel D.H. et al.The incidence, timing and management of biliary tract complications after orthotopic liver transplantation.Ann Surg. 1994; 219: 40-45Crossref PubMed Scopus (416) Google Scholar, 8Sossenheimer M. Slivka A. Carr-Locke D. Management of extrahepatic biliary disease after orthotopic liver transplantation review of the literature and results of a multicenter survey.Endoscopy. 1996; 28: 565-571Crossref PubMed Scopus (43) Google Scholar, 9Hintze R.E. Abou-Rebyeh H. Adler A. et al.Endoscopic therapy of ischemic type biliary lesions (ITBL) in patients after orthotopic liver transplantation.Z Gastroenterol. 1999; 37: 13-20PubMed Google Scholar, 10Hintze R.E. Adler A. Veltzke W. et al.Endoscopic management of biliary complications after orthotopic liver transplantation.Hepatogastroenterology. 1997; 44: 258-262PubMed Google Scholar, 11Rerknimitr R. Sherman S. Fogel E.L. et al.Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis endoscopic findings and results of therapy.Gastrointest Endosc. 2002; 55: 224-231Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar, 12Thuluvath P.J. Atassi T. Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation.Liver Int. 2003; 23: 156-162Crossref PubMed Scopus (154) Google Scholar, 13Morelli J. Mulcahy H.E. Willner I.R. et al.Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement.Gastrointest Endosc. 2003; 58: 374-379Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar, 14Pfau P.R. Kochman M.L. Lewis J.D. et al.Endoscopic management of postoperative biliary complications in orthotopic liver transplantation.Gastrointest Endosc. 2000; 52: 55-63Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar, 15Mosca S. Militerno G. Guardascione M.A. et al.Late biliary tract complications after orthotopic liver transplantation diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography.J Gastroenterol Hepatol. 2000; 15: 654-660Crossref PubMed Scopus (46) Google Scholar, 16Park J.S. Kim M.H. Lee S.K. et al.Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation.Gastrointest Endosc. 2003; 57: 78-85Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar However, the number of treated patients in all cited studies was rather small.5Vallera R.A. Cotton P.B. Clavien P.A. Biliary reconstruction for liver transplantation and management of biliary complications overview and survey of current practice in the United States.Liver Transplant Surg. 1995; 1: 143-152Crossref PubMed Scopus (86) Google Scholar, 6Gholson C. Zibari G. McDonald J.C. Endoscopic diagnosis and management of biliary complications following orthotopic liver transplantation.Dig Dis Sci. 1996; 41: 1045-1053Crossref PubMed Scopus (51) Google Scholar, 7Greif F. Bronsther O.L. Van Thiel D.H. et al.The incidence, timing and management of biliary tract complications after orthotopic liver transplantation.Ann Surg. 1994; 219: 40-45Crossref PubMed Scopus (416) Google Scholar, 8Sossenheimer M. Slivka A. Carr-Locke D. Management of extrahepatic biliary disease after orthotopic liver transplantation review of the literature and results of a multicenter survey.Endoscopy. 1996; 28: 565-571Crossref PubMed Scopus (43) Google Scholar, 9Hintze R.E. Abou-Rebyeh H. Adler A. et al.Endoscopic therapy of ischemic type biliary lesions (ITBL) in patients after orthotopic liver transplantation.Z Gastroenterol. 1999; 37: 13-20PubMed Google Scholar, 10Hintze R.E. Adler A. Veltzke W. et al.Endoscopic management of biliary complications after orthotopic liver transplantation.Hepatogastroenterology. 1997; 44: 258-262PubMed Google Scholar, 11Rerknimitr R. Sherman S. Fogel E.L. et al.Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis endoscopic findings and results of therapy.Gastrointest Endosc. 2002; 55: 224-231Abstract Full Text Full Text PDF PubMed Scopus (253) Google Scholar, 12Thuluvath P.J. Atassi T. Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation.Liver Int. 2003; 23: 156-162Crossref PubMed Scopus (154) Google Scholar, 13Morelli J. Mulcahy H.E. Willner I.R. et al.Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement.Gastrointest Endosc. 2003; 58: 374-379Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar, 14Pfau P.R. Kochman M.L. Lewis J.D. et al.Endoscopic management of postoperative biliary complications in orthotopic liver transplantation.Gastrointest Endosc. 2000; 52: 55-63Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar, 15Mosca S. Militerno G. Guardascione M.A. et al.Late biliary tract complications after orthotopic liver transplantation diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography.J Gastroenterol Hepatol. 2000; 15: 654-660Crossref PubMed Scopus (46) Google Scholar, 16Park J.S. Kim M.H. Lee S.K. et al.Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation.Gastrointest Endosc. 2003; 57: 78-85Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar Experience in endoscopic therapy after LDLT is very limited. Park et al16Park J.S. Kim M.H. Lee S.K. et al.Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation.Gastrointest Endosc. 2003; 57: 78-85Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar recently reported the successful endoscopic/radiologic therapy of 16 patients after LDLT with posttransplant biliary strictures. Most of the patients were treated by percutaneous transhepatic cholangiography because of biliodigestive anastomosis, with a success rate of around 67%. Unfortunately, which type of LDLT had been performed in this study is not apparent. We report successful endoscopic treatment of posttransplant biliary strictures after RLDLT with duct-to-duct anastomosis. The rate of biliary stricture occurrence in this series was 30% and therefore comparable with other series of patients after orthotopic liver transplantation. The success rate of the endoscopic treatment via ERC was very high and, in all patients, the surgical application of a biliodigestive anastomosis could be avoided. Bilirubin and alkaline phosphatase levels returned to normal or decreased significantly after completion of endoscopic therapy. Despite the increased difficulty of the endoscopic procedure caused by the postsurgical anatomic situation, no severe complications occurred. Only mild pancreatitis and cholangitis were seen. Clinically significant bleeding after sphincterotomy occurred in 1 patient, but it was managed by epinephrine injection. Technically, endoscopic therapy of posttransplant biliary strictures after RLDLT with duct-to-duct anastomosis often is complex and challenging because of the multiple anastomoses between hepatic ducts of the donor and the common bile duct of the recipient, often resulting in an almost acute angle between recipient and donor bile ducts. Selective intubation of these single-duct insertions is difficult but can be managed using a rotatable sphincterotome (Autotome; Boston Scientific), allowing to target a guidewire selectively into a distinct duct. In conclusion, endoscopic therapy of adult-to-adult right living related liver transplantation with duct-to-duct anastomosis is feasible and successful. The duct-to-duct anastomosis offers the possibility of endoscopic treatment. Endoscopic treatment of posttransplant biliary strictures is safe and shows a low specific complication rate. Endoscopic Management of Biliary Stricture After Right-Lobe Living-Donor Liver Transplantation With Biliary AnastomosisClinical Gastroenterology and HepatologyVol. 4Issue 10PreviewDear Editor: Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 4Issue 10PreviewIn their letter, Yazumi and Chiba present similar results to ours in the endoscopic treatment of post–living-donor liver transplant biliary strictures. The main difference in their approach is that they do the endoprosthetic treatment without preceding sphincterotomy. Their rationale to do this is a potential higher risk of cholangitis as a result of duodenobiliary reflux. They assume that our group did sphincterotomy to avoid postinterventional pancreatitis. Full-Text PDF" @default.
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• W2029959851 date "2005-11-01" @default.
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• W2029959851 title "Endoscopic Therapy of Posttransplant Biliary Stenoses After Right-Sided Adult Living Donor Liver Transplantation" @default.
• W2029959851 cites W1975635116 @default.
• W2029959851 cites W1982144744 @default.
• W2029959851 cites W1996614556 @default.
• W2029959851 cites W1997978047 @default.
• W2029959851 cites W1998559862 @default.
• W2029959851 cites W2007908020 @default.
• W2029959851 cites W2011254995 @default.
• W2029959851 cites W2018059114 @default.
• W2029959851 cites W2031455022 @default.
• W2029959851 cites W2068104237 @default.
• W2029959851 cites W2080924704 @default.
• W2029959851 cites W2085283671 @default.
• W2029959851 cites W2125494054 @default.
• W2029959851 cites W2146973595 @default.
• W2029959851 cites W2150364671 @default.
• W2029959851 cites W2528371475 @default.
• W2029959851 doi "https://doi.org/10.1016/s1542-3565(05)00850-5" @default.
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