Management of Post Liver Transplant Biliary Strictures
Management of Post Liver Transplant Biliary Strictures
Published On: 04 Aug, 2023 5:42 PM | Updated On: 04 Aug, 2023 6:50 PM
Management of Post Liver Transplant Biliary Strictures
Endoscopic Interventions
Biliary anastomosis has long been considered the Achilles heel of orthotopic liver transplantation (OLT).
Biliary strictures are the most frequently described complication, affecting 4% to 15% of patients after liver transplant.
It can be anastomotic (85%) or nonanastomotic.
Anastomotic strictures appear more often in living donor liver transplantation (LDLT) than in deceased donor liver transplant (DDLT), in the percentage of 13% to 36% and 5% to 15%, respectively.
Prompt and systematic evaluation of abnormal liver enzymes after liver transplant surgery is crucial to identify biliary strictures at an early stage.
Clinicians are advised to retain a high index of suspicion, especially in the first year after the transplant, and investigate all liver function abnormalities with a magnetic resonance cholangiopancreatography (MRCP) to allow early recognition.
Endoscopic retrograde cholangiopancreatography should be used as the initial therapy for biliary strictures.
Endoscopist must ascertain the full operative details of the biliary and liver anatomy.
The rendezvous method, magnetic compression anastomosis and peroral cholangioscopy, endoscopic ultrasound guided-biliary drainage (EUS-BD) are options in difficult scenarios.
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