Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Outcomes of endoscopic retrograde cholangiography and percutaneous transhepatic biliary drainage in liver transplant recipients with a Roux-en-Y biliary-enteric anastomosis

  • Divyanshoo Rai Kohli (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Bashar A. Aqel (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Nicole L. Segaran (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • M. Edwyn Harrison (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Norio Fukami (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Douglas O. Faigel (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Adyr Moss (Department of Surgery, Mayo Clinic Transplant Center) ;
  • Amit Mathur (Department of Surgery, Mayo Clinic Transplant Center) ;
  • Winston Hewitt (Department of Surgery, Mayo Clinic Transplant Center) ;
  • Nitin Katariya (Department of Surgery, Mayo Clinic Transplant Center) ;
  • Rahul Pannala (Division of Gastroenterology and Hepatology, Mayo Clinic)
  • Received : 2022.06.02
  • Accepted : 2022.08.01
  • Published : 2023.02.28
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Abstract

Backgrounds/Aims: Data regarding outcomes of endoscopic retrograde cholangiography (ERC) in liver transplant (LT) recipients with biliary-enteric (BE) anastomosis are limited. We report outcomes of ERC and percutaneous transhepatic biliary drainage (PTBD) as first-line therapies in LT recipients with BE anastomosis. Methods: All LT recipients with Roux-BE anastomosis from 2001 to 2020 were divided into ERC and PTBD subgroups. Technical success was defined as the ability to cannulate the bile duct. Clinical success was defined as the ability to perform cholangiography and therapeutic interventions. Results: A total of 36 LT recipients (25 males, age 53.5 ± 13 years) with Roux-BE anastomosis who underwent biliary intervention were identified. The most common indications for a BE anastomosis were primary sclerosing cholangitis (n = 14) and duct size mismatch (n = 10). Among the 29 patients who initially underwent ERC, technical success and clinical success were achieved in 24 (82.8%) and 22 (75.9%) patients, respectively. The initial endoscope used for the ERC was a single balloon enteroscope in 16 patients, a double balloon enteroscope in 7 patients, a pediatric colonoscope in 5 patients, and a conventional reusable duodenoscope in 1 patient. Among the 7 patients who underwent PTBD as the initial therapy, six (85.7%) achieved technical and clinical success (p = 0.57). Conclusions: In LT patients with Roux-BE anastomosis requiring biliary intervention, ERC with a balloon-assisted enteroscope is safe with a success rate comparable to PTBD. Both ERC and PTBD can be considered as first-line therapies for LT recipients with a BE anastomosis.

Keywords

Acknowledgement

Divyanshoo Rai Kohli has been supported from Olympus.

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