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The role of endoscopy in biliary complications after liver transplantation

Authors
Andrés Cárdenas, MD, MMSc, AGAF
Karen L Krok, MD
Paul J Thuluvath, MBBS, MD, FRCP
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Biliary tract complications are an important cause of morbidity and mortality in liver transplantation (LT) recipients. The most frequent are biliary tract strictures, bile leaks, and bile duct stones. The estimated incidence of these complications ranges between 10 and 25 percent in various reports, although rates have been decreasing over time [1-7]. Most can be managed successfully with endoscopic retrograde cholangiography if there is a duct-to-duct anastomosis.

This topic review focuses on the various biliary complications after LT and their endoscopic management. Reviews of other complications following liver transplantation are presented separately. (See "Liver transplantation in adults: Long-term management of transplant recipients" and "Infectious complications in liver transplantation".)

TYPES OF COMPLICATIONS

Biliary complications (bile duct strictures, leaks, and stones) following LT can be categorized as early (within four weeks) or late [8]. Biliary strictures can be further divided into anastomotic, nonanastomotic, and diffuse intrahepatic strictures. Other complications such as bile casts, sphincter of Oddi dysfunction, mucocele, and hemobilia are rare and most also can be managed endoscopically (table 1).

RISK FACTORS

There are several risk factors for the development of biliary complications after LT (table 2):

Some studies have suggested that a major risk factor is the type of biliary reconstruction (duct-to-duct choledochocholedochostomy versus Roux-en-Y choledochojejunostomy), but it is generally agreed that the rate of complications is similar (or only marginally higher) with the Roux-en-Y technique compared with choledochocholedochostomy [2,9-12]. Duct-to-duct anastomosis of the common bile duct has the advantage of easy access to the biliary system and preservation of the sphincter of Oddi, which in theory avoids reflux of contents into the bile duct [13].

                    

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Literature review current through: Nov 2016. | This topic last updated: Thu Apr 21 00:00:00 GMT+00:00 2016.
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