Endoscopic treatment of post-liver transplantation biliary leaks with stent placement across the leak site

• Published in: Gastrointestinal endoscopy Vol. 54; no. 4; pp. 471 - 475
• Main Authors: Morelli, Joseph, Mulcahy, Hugh E., Willner, Ira R., Baliga, Prabhakar, Chavin, Kenneth D., Patel, Rig, Payne, Mark, Cotton, Peter B., Hawes, Robert, Reuben, Adrian, Cunningham, John T.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.10.2001; Elsevier
• Subjects: Bile; Bile Ducts; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde; Diseases of the digestive system; Female; Humans; Liver Transplantation; Male; Medical sciences; Middle Aged; Postoperative Complications - therapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Stents; Treatment Outcome; Human; Biliary tract; Liver; Leak; Instrumentation therapy; Surgical anastomosis; Transplantation; Homotransplantation; Stent; Treatment; Endoscopic approach; Surgery; Complication
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/mge.2001.117762

Background: Biliary tract leaks occur in over 10% of patients undergoing liver transplantation and are the most common cause of biliary tract-related death in these patients. A number of treatment options are available, but a standard approach has not been established. Methods: Twenty-six patients were retrospectively studied who had post-transplantation leaks develop with special reference to those who underwent endoscopic placement of a “leak-bridging” stent. Results: Endoscopic retrograde cholangiography was performed in all cases with no procedure-related complications. Twenty-four patients had a leak-bridging stent, 1 a transpapillary stent, and 1 a nasobiliary drain. Leak resolution occurred in 23 cases (88%) after initial stent placement. The median time to stent removal was 8 weeks. Three patients did not respond to initial treatment; 2 were successfully treated with another stent and a single patient required surgical repair. Four deaths occurred during follow-up, all unrelated to the biliary leak. Conclusions: Placement of a leak-bridging stent is a safe and effective initial treatment for post-liver transplantation biliary leaks. (Gastrointest Endosc 2001;54:471-5.)