Magnetic compression anastomosis is useful in biliary anastomotic strictures after living donor liver transplantation

Abstract

Background: An anastomotic biliary stricture is a complication of living donor liver transplantation (LDLT) performed using duct-to-duct anastomosis. Despite advances in treating this complication, there is no one established treatment protocol.Objective: To investigate the safety, effectiveness, and mid-term outcome of magnetic compression anastomosis (MCA) for treating biliary obstruction after LDLT when the obstruction cannot be resolved by using percutaneous or peroral methods.Design: Retrospective, observational study with standardized treatment and follow-up.Setting: Tertiary-care academic medical center.Patients: Twelve patients underwent MCA procedures to treat anastomosis site stricture after LDLT.Interventions: MCA.Main Outcome Measurements: Bile duct patency, technique performance, and complications were evaluated.Results: We achieved magnet approximation at the anastomotic stricture in 10 of 12 patients (83.3%). The magnets failed to approximate in 2 patients. We achieved recanalization of the stricture site in 10 of 10 patients.We removed an internal catheter in 9 patients. The mean interval from magnet approximation to removal was 74.2 days (range 14-181 days). The mean time from recanalization to removal of the internal catheter was 183 days (range 51-266 days). Patients were examined regularly after removing the internal catheter with a meanfollow-up period of 331 days (range 148-581 days). The observed MCA-related complications consisted of 1 case of mild cholangitis and 1 recurrence of the anastomotic stricture.Limitations: Nonrandomized study design.Conclusions: MCA safely and effectively resolved post-LDLT biliary duct-to-duct anastomotic strictures that could not be resolved using conventional methods, such as ERCP and percutaneous transhepatic biliary drainage. (Gastrointest Endosc 2011;74:1040-8.)