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KMID : 1038120170500050451
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Clinical Endoscopy
2017 Volume.50 No. 5 p.451 ~ p.463
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An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications
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Lee Hyun-Woo
Shah Najmul Hassan
Lee Sung-Koo
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Abstract
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Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%?45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques?such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy?combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.
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KEYWORD
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Liver transplantation, Biliary tract diseases, Choledocholithiasis, Anastomotic leak, Cholangiopancreatography, endoscopic retrograde
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