Table 1.
Results of endoscopic management of biliary complications after adult living donor liver transplantation: A review of the literature
| Ref.1 | Type of biliary complication | Initial technical success, n (%)2 | Final therapeutic success, n (%)3 | Recurrence at a mean follow-up months, n (%)4 | Endoscopic treatment modality | Number of ERC session per patient5 | Duration for final success (mo)5 | Factors affecting endoscopic treatment outcomes | ||
| Hisatsune et al[41] D-D | Stricture | 14/22 | (63.6) | 2/14 | (14.3) | - | IS | 1 | 12 | Number of the proximal duct at D-D |
| Shah et al[35] D-D | Stricture | 3/4 | (75.0) | 3/3 | (100) | - | BD and/or PS | 1.5 | 2.3 | |
| Leakage | 8/8 | (100) | 8/8 | (100) | - | PS with/without ES | 2 | 1.4 | ||
| Zoepf et al[26] D-D | Stricture | 7/12 | (58.3) | 7/7 | (100) | 1/7 (14.3) at 10.0 | BD and/or PS | 3.5 | 8 | |
| Yazumi et al[12] D-D | Stricture | 48/75 | (64.0) | 28/55 | (50.9) | 3/28 (10.7) at 1.8 | IS with/without BD | - | 9 | Crane-neck deformity |
| Leakage | 13/16 | (50.0) | 8/13 | (61.5) | - | ENBD | - | 0.6 | Non-anastomotic stricture | |
| Tsujino et al[11] D-D | Stricture | 12/17 | (70.6) | 9/12 | (75.0) | 4/9 (44.4) at 10.1 | BD with ENBD/IS | 4.1 | - | |
| Lee et al[22] D-D | Stricture | 12/17 | (70.6) | 7/14 | (50.0) | 0/7 (0.0) at 13.1 | BD with ENBD/PS | 3.9 | 7.2 | Stricture |
| Sharp angulation of D-D | ||||||||||
| Leakage | 11/13 | (84.6) | 9/11 | (81.8) | 0/9 (0.0) at 13.1 | PS or ENBD | 2.2 | 3 | Concomitant bile leakage | |
| Tarantino et al[16] D-D | Stricture | 14/20 | (70.0) | 7/14 | (64.3) | - | BD with double PS | 3.4 | - | Continuous bile leakage despite PS |
| Leakage | 11/13 | (33.3) | 3/4 | (75.0) | - | ES with PS | 2.3 | - | Persistence of stricture after 1 yr | |
| Both | 4/6 | (66.7) | 0/4 | (0.0) | - | - | - | - | ||
| Kato et al[59] D-D | Stricture | 31/41 | (75.6) | 28/35 | (80.0) | 7/28 (25.0) at 9.3 | BD with PS | 4 | 14.5 | Concomitant bile leakage |
| Kim et al[40] D-D | Stricture | - | 38/60 | (63.3) | 5/38 (13.2) at 7.9 | BD with PS | 3 | - | Shape of distal duct at D-D: pouched | |
| Kobayashi et al[66] D-D | Stricture | - | 7/16 | (43.8) | - | - | - | - | Delayed diagnosis of stricture | |
| Seo et al[43] D-D | Stricture | 15/26 | (57.6) | 20/29 | (68.9) | 6/20 (30.0) at 28.0 | BD with PS | 2.3 | 6.8 | Late onset over 24 wk |
| Delayed diagnosis of stricture | ||||||||||
| Short duration of biliary stenting | ||||||||||
| Gómez et al[18] D-D | Stricture | 4/10 | (40.0) | 2/4 | (50.0) | - | BD with/without PS | 2 | - | |
| Leakage | 3/4 | (75.0) | 3/3 | (100) | - | ES with/without PS | 3 | - | ||
| Chang et al[28] D-D | Stricture | 63/101 | (62.4) | 48/90 | (53.3) | - | BD with PS | 3.2 | 11 | Non-anastomotic stricture |
| Hepatic artery stenosis | ||||||||||
| Lee et al[23] D-D | Stricture | 64/137 | (46.7) | 38/68 | (55.9) | - | PS or ENBD | 4.8 | - | Stricture-to-ERC interval |
| Morphology of stricture | ||||||||||
| : narrow, separate duct, nonvisualized | ||||||||||
| Shape of distal duct at D-D: round tip | ||||||||||
| Kim et al[61] D-D | Stricture | 82/147 | (55.8) | 52/141 | (36.9) | 6/52 (11.5) at 21.1 | BD with PS | 6.3 | 12.7 | Early onset within 1 yr after LDLT |
| Yaprak et al[58] D-D | Stricture | - | 7/13 | (53.8) | - | - | - | - | Long length of stricture | |
| Leakage | - | 5/7 | (71.4) | - | - | - | - | More than 1 bile duct anastomosis | ||
| Chan et al[142] D-D | Stricture | 8/8 | (100) | 6/8 | (75.0) | 0/6 (0.0) at 3.0 | BD with PS | 4.7 | 4.2 | Disuse of intraoperative biliary stent |
| Kurita et al[67] D-D | Stricture | 94/118 | (79.7) | 81/92 | (88.0) | 8/81 (9.9) at 53.0 | BD with IS | 1.4 | 6.3 | Use of ES |
| Hsieh et al[71] D-D | Stricture | 32/38 | (84.2) | 38/38 | (100) | 8/38 (21.1) at 9.45 | BD and maximal PS | 4 | 5.3 | Right lobe liver graft |
| High-grade stricture | ||||||||||
| Sharp angulation of D-D | ||||||||||
| Conventional PS vs maximal PS | ||||||||||
| Chok et al[37] D-D | Stricture | - | 41/56 | (73.2) | - | BD with/without PS | 3 | - | Younger recipient age | |
| Longer operation time | ||||||||||
| Shape of distal duct at D-D: pouched | ||||||||||
| Initial bile leakage | ||||||||||
| Na et al[24] D-D | Stricture | 53/65 | (81.5) | 112/129 | (86.8) | - | BD and maximal PS | 3.2 | - | Early period of transplant experience |
| - | 59/64 | (92.2) | - | Rendezvous | - | - | ||||
| Chang et al[86] D-D | Stricture | 20/20 | (100) | 13/20 | (65.0) | - | Rendezvous | 2 | 7.2 | Sharp or twisted angle at stricture |
| Mita et al[77] C-J | Stricture | 7/22 | (31.8) | - | 0/7 (0.0) at 13.3 | BD | 2 | 2.5 | Tube jejunostomy in long Roux limb | |
| (deep enteroscopy) | ||||||||||
| Kamei et al[82] C-J | Stricture | 5/9 | (55.6) | 7/9 | (77.8) | 4/7 (57.1) at 27.6 | BD | 2.1 | - | Use of a single ERC intervention |
| (deep enteroscopy) | ||||||||||
| Jang et al[97] D-D | Stricture | 10/12 | (83.3) | 10/10 | (100) | 1/9 (11.1) at 3.3 | Magnetic compression anastomosis | - | 2.5 | Length of stricture |
| : magnet approximation | : recanalization | LDLT-to-ERC interval | ||||||||
| 9/10 | (90.0) | 6.1 | Architecture of the bile duct | |||||||
| : stent-free | Strength of the magnet | |||||||||
References: Author, Type of biliary reconstruction in study population;
Initial technical success, n (%): patients who underwent successful ERC intervention/patients receiving a first session of ERC (excluding prior transhepatic rendezvous);
Final therapeutic success, n (%): patients who achieved cholangiographic resolution without need for further endoscopic, surgical, percutaneous procedures (e.g., stent-free) / patients treated by ERC interventions;
Recurrence, n (%): patients with recurrent biliary problems with cholangiographic evidence and the need for subsequent intervention/patients who resolved;
Values are expressed as mean. BD: Balloon dilatation; C-J: Biliary anastomosis with Roux-en-Y choledochojejunostomy; D-D: Duct-to-duct biliary anastomosis; ENBD: Endoscopic nasobiliary drainage; ERC: Endoscopic retrograde cholangiography; ES: Endoscopic sphincterotomy; IS: Inside-stent placement above the intact sphincter of Oddi; PS: Plastic stent placement.