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Percutaneous transhepatic biliary drainage may serve as a successful rescue procedure in failed cases of endoscopic therapy for a post-living donor liver transplantation biliary stricture

 Eak Seong Kim  ;  Byung Jun Lee  ;  Jong Yun Won  ;  Jong Yong Choi  ;  Dong Ki Lee 
 GASTROINTESTINAL ENDOSCOPY, Vol.69(1) : 38-46, 2009 
Journal Title
Issue Date
Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Cholangiopancreatography, Endoscopic Retrograde/methods* ; Cholestasis/diagnosis* ; Cholestasis/etiology ; Cholestasis/therapy* ; Cohort Studies ; Drainage/methods* ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation/adverse effects* ; Liver Transplantation/methods ; Living Donors ; Male ; Middle Aged ; Palliative Care/methods ; Postoperative Complications/diagnosis ; Postoperative Complications/therapy ; Probability ; Recurrence ; Risk Assessment ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography, Doppler
BACKGROUND: Although a biliary stricture is one of the most important complications that develop after living donor liver transplantation (LDLT), a standard approach has not yet been established. OBJECTIVE: The aim of this study was to evaluate the usefulness of nonoperative management in repairing a post-LDLT biliary stricture. DESIGN: A total of 60 patients were referred, from July 2004 to July 2007, for management of a post-LDLT biliary stricture. The patients had ERCP if the hepatic arterial flow was patent on a Doppler sonography. If endoscopic therapy failed, then percutaneous transhepatic drainage (PTBD) was performed to dilate the stricture. If the percutaneous approach also failed, then a repeated PTBD was performed after a 3-dimensional abdominal CT (3D-CT). SETTING: Division of Gastroenterology, Department of Internal Medicine, Yongdong Severance Hospital. PATIENTS: Sixty patients were referred from Catholic University Hospital of Korea for ERCP. RESULTS: ERCP was performed on all 60 patients, and 38 (63%) were successfully treated. When the shape of the distal side of the bile-duct anastomosis was classified into 3 categories (pouched, triangular, and intermediate), the pouched shape showed the lowest success rate of endoscopic therapy (25% [4/16]). Fifteen of 22 patients in whom endoscopic therapy failed were treated by using PTBD. Nine of the 15 patients were successfully managed in the first PTBD attempt, and 4 of the 6 patients in whom the first attempt of PTBD failed had repeated PTBD after a 3D-CT. Four patients were successfully treated with repeated PTBD of the alternative branch approach after a 3D-CT. CONCLUSIONS: ERCP is a feasible first modality in the treatment of a post-LDLT biliary stricture, but, in failed cases, especially in the pouched shape, PTBD can be attempted. When initial PTBD trial fails, a biliary-tract examination, such as a 3D-CT, can be useful for a repeated PTBD trial
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Eak Seong(김익성)
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Lee, Dong Ki(이동기) ORCID logo https://orcid.org/0000-0002-0048-9112
Lee, Byung Jun(이병준)
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