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An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications

이성구|이현우|Najmul Hassan Shah
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2017.09|Clinical Endoscopy|제50권 제5호|pp. 451-463

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참고문헌

키워드

Liver transplantationCholangiopancreatographyendoscopic retrogradeBiliary tract diseasesCholedocholithiasisAnastomotic leak
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초록

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.

Abstract

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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관련 논문AI추천

Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Patients with Post-Liver Transplant Biliary Complications: Results of a Cohort Study with Long-Term Follow-UpAlessandro Repici, Alessandro Ricchiuti, Arnaldo Ferrari, Chiara Giordanino, Claudia Sanna, Claudio Barletti, Dario Reggio, Giorgio Saracco, Giovannino Ciccone, Ilaria Giono, Ileana Baldi, Mario Rizzetto, Mauro Salizzoni, Serafino Recchia거트앤리버 소화기연관학회협의회 · Gut and Liver2011 · 제5권 제3호Biliary Strictures after Liver Transplantation류충헌, Sung-Koo Lee거트앤리버 소화기연관학회협의회 · Gut and Liver2011 · 제5권 제2호Endoscopic Management of Bile Leakage after Liver Transplantation김명환, 박도현, 서동완, 송태준, 오동욱, 이상수, 이성구거트앤리버 소화기연관학회협의회 · Gut and Liver2015 · 제9권 제3호Endoscopic Management of Anastomotic Strictures after Liver TransplantationDong Wook Lee, Hyeong Ho Jo, Juveria Abdullah, Michel Kahaleh대한소화기내시경학회 · Clinical Endoscopy2016 · 제49권 제5호Endoscopic management of anastomotic stricture after living-donor liver transplantation이동욱, 한지민대한내과학회 · The Korean Journal of Internal Medicine2019 · 제34권 제2호Unilateral Versus Bilateral Biliary Drainage for Post-Transplant Anastomotic Stricture백우현, 최진호대한소화기내시경학회 · Clinical Endoscopy2020 · 제53권 제3호

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