Surgery, Gastroenterology and Oncology

Background: Endoscopic retrograde cholangiography (ERC) with balloon dilation and stenting is the curative treatment for biliary anastomotic (AS) strictures after living donor liver transplantation (LDLT). The aim of this study was to assess the technical feasibility and clinical outcomes of combined endoscopic and percutaneous therapy for biliary AS stricture in adult right-lobe living donor liver transplantation with duct to duct anastomosis.

Materials and methods: Between January 2008 and December 2015, 648 patients receiving right-lobe LDLT in our hospital were analyzed for biliary complications. When biliary strictures were diagnosed, patients underwent ERC first as a diagnostic as well as treatment modality to dilate the strictures and biliary stenting. If ERC failed, percutaneous transhepatic cholangiography (PTC) and or combined PTC and ERC were done.

Results: Eighty-two biliary strictures were diagnosed in 648 recipients (13%; 82 648) at an average of 256 (7-1979) days after LDLT. Among 82 patients (age 52.6 +- 9.6 years, range 24-72), 40 patients were successfully treated by ERC, 5 by PTC, and 9 by combined PTC and ERC. In successful ERC with an average of 5.03 +- 2.96 sessions, 11 +-11.0 plastic stents in total and 2+-1 stents at each ERC session were placed. The mean time to stricture resolution was 708 +- 532 (28-1967), 298 +- 135 (145-398), and 499 +- 239 (288-827) days for patients receiving ERC, PTC, and combined PTC and ERC, respectively.

Conclusions: Biliary complications following LDLT is associated with high mortality. In severe biliary strictures, the procedure that combines PTC and ERC can be curative in patients with prior failed ERC treatment.

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