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• W8037951 abstract "Biliary tract disease is an important cause of allograft dysfunction. In the early postoperative period, T-tube displacement is the most common cause of biliary obstruction. Later, strictures, stones, and ampullary dysfunction become more common causes of abnormal liver tests (Sossenheimer et al. 1996). Hepatocellular dysfunction due to allograft rejection has to be differentiated from extrahepatic biliary disease. While abdominal ultrasonography with color Doppler examination detects hepatic arterial thrombosis in a majority of cases, suspicion of extrahepatic biliary disease needs to be confirmed by cholangiography. The three available modalities, namely endoscopic retrograde cholangiopancre- atography (ERCP), percutaneous transhepatic cholangiography (PTC) or T-tube cholangiography, and magnetic resonance cholangiopancreatography (MRCP), are complementary to each other in this regard. MRCP is entirely noninvasive and is the preferred mode when only a diagnostic examination is needed, avoiding the morbidity associated with the invasive procedures. However, the disadvantages include the higher costs and inapplicability when a simultaneous therapeutic intervention is required, as in the case of obstructive pathology. Until recently, percutaneous, interventional radiological techniques were predominantly employed for the diagnosis and management of biliary complications following orthotopic liver transplantation (OLT) (Rossi et al. 1994; Colledan et al. 1994; Girardot et al. 1994; Letourneau and Castaneda-Zuniga 1990; Keogan et al. 1999; Klein et al. 1991). However, over the past few years, ERCP has become the initial method of choice (Safadi et al. 1999; Hintze et al. 1997,1999; Macfarlane et al. 1996; Delgado et al. 1993; Donovan 1993; Van Thiel et al. 1993; Alvarado et al. 1995; Porayko et al. 1995). The advantages of ERCP over percutaneous method are: (a) it is physiological, (b) it is associated with less morbidity, (c) there are fewer complications, and (d) it is better tolerated by the patient. However, ERCP cannot replace PTC entirely. In fact, PTC is the only nonsurgi- cal option (a) to manage the biliary complications following OLT when a choledochojejunal (CDJ) anastomosis is used, (b) in the presence of intrahe- patic ductal strictures, and (c) when endoscopic procedures fail in choledochocholedochal (CDCD) anastomosis. Although PTC is equally applicable irrespective of the type of anastomosis, with the wider use of CDCD the endoscopic approach has become the initial method of choice for nonsurgical management of post-OLT biliary complications." @default.
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• W8037951 date "2003-01-01" @default.
• W8037951 modified "2023-09-26" @default.
• W8037951 title "Therapeutic Endoscopy in the Management of Biliary Complications After Orthotopic Liver Transplantation" @default.
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• W8037951 doi "https://doi.org/10.1007/978-3-642-55955-6_9" @default.
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