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Surgical Endoscopy

Published in:

01-06-2015

Endoscopic ultrasound: valuable tool for diagnosis of biliary complications in liver transplant recipients?

Authors: Anna Hüsing, Vito R. Cicinnati, Susanne Beckebaum, Christian Wilms, Hartmut H. Schmidt, Iyad Kabar

Published in: Surgical Endoscopy | Issue 6/2015

Abstract

Background

Biliary complications after liver transplantation (LT) are still common and are an important cause of mortality and morbidity. Until now, endoscopic retrograde cholangiopancreatography (ERCP) has been considered the gold standard for diagnosing such complications. The aim of this study was to evaluate the diagnostic yield and therapeutic impact of endoscopic ultrasound (EUS) in the management of biliary complications after LT.

Methods

Thirty-seven liver transplant patients who presented with clinical, biochemical, sonographic, and/or histological evidence of biliary complications, and who first received EUS followed by ERCP, were enrolled into this prospective observational study. Subsequently, we evaluated the value of EUS in detecting and classifying biliary complications after LT.

Results

Thirty-seven biliary complications were detected in 32 patients. Endoscopic ultrasound showed an overall sensitivity and accuracy of 94.6 % each. In cases of biliary cast and ischemic cholangiopathy, EUS was found to be diagnostically superior to ERCP and has had, in these cases, a significant impact on clinical decision-making. However, EUS was less reliable when diagnosing anastomotic strictures.

Conclusion

EUS can complement ERCP to improve diagnosis of biliary complications after LT and help guide treatment strategies to address these complications.

Rerknimitr R, Sherman S, Fogel EL, Kalayci C, Lumeng L, Chalasani N et al (2002) Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy. Gastrointest Endosc 55(2):224–231CrossRefPubMed

Bilbao MK, Dotter CT, Lee TG, Katon RM (1976) Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology 70(3):314–320PubMed

Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P (2013) Biliary complications after liver transplantation: old problems and new challenges. Am J Trans 13(2):253–265

Choo L, Conway J, Mishra G (2012) The role of endoscopic ultrasound in biliary obstruction. Curr Gastroenterol Rep 14(6):520–527

Chen CH, Yang CC, Yeh YH, Yang T, Chung TC (2013) Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography. J Formos Med Assoc. doi:10.1016/j.jfma.2013.09.005

Hollerbach S (2008) EUS and ERCP: brothers in arms. Gastrointest Endosc 68(3):467–469CrossRefPubMed

Rosch T, Meining A, Fruhmorgen S, Zillinger C, Schusdziarra V, Hellerhoff K et al (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55(7):870–876CrossRefPubMed

Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P (2008) EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc 67(2):235–244CrossRefPubMed

Arain MA, Attam R, Freeman ML (2013) Advances in endoscopic management of biliary tract complications after liver transplantation. Liver Transpl 19(5):482–498

10.

Low VH (1997) The normal retrograde cholangiogram: a definition of normal caliber. Abdom Imaging 22(5):509–512CrossRefPubMed

11.

Campbell WL, Foster RG, Miller WJ, Lecky JW, Zajko AB, Lee KY (1992) Changes in extrahepatic bile duct caliber in liver transplant recipients without evidence of biliary obstruction. AJR Am J Roentgenol 158(5):997–1000CrossRefPubMed

12.

Mahour GH, Wakim KG, Ferris DO (1967) The common bile duct in man: its diameter and circumference. Ann Surg 165(3):415–419CrossRefPubMedCentralPubMed

13.

Potthoff A, Hahn A, Kubicka S, Schneider A, Wedemeyer J, Klempnauer J, et al (2013) Diagnostic value of ultrasound in detection of biliary tract complications after liver transplantation. Hepat Mon 13(1):e6003

14.

Girardot C, Legmann P, Limot O (1994) Biliary complications after liver transplantation. Contribution of imaging–percutaneous treatment. Ann Radiol (Paris) 37(5):357–367

15.

Katz LH, Benjaminov O, Belinki A, Geler A, Braun M, Knizhnik M, et al (2010) Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography—long-term follow-up. Clin Trans 24(5):E163–E169

16.

Valls C, Alba E, Cruz M, Figueras J, Andia E, Sanchez A et al (2005) Biliary complications after liver transplantation: diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol 184(3):812–820CrossRefPubMed

17.

Beswick DM, Miraglia R, Caruso S, Marrone G, Gruttadauria S, Zajko AB, et al (2012) The role of ultrasound and magnetic resonance cholangiopancreatography for the diagnosis of biliary stricture after liver transplantation. Eur J Radiol 81(9):2089–2092

18.

Shastri YM, Hoepffner NM, Akoglu B, Zapletal C, Bechstein WO, Caspary WF et al (2007) Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation. World J Gastroenterol 13(20):2819–2825PubMedCentralPubMed

19.

Beltran MM, Marugan RB, Oton E, Blesa C, Nuno J (2005) Accuracy of magnetic resonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation. Trans Proc 37(9):3924–3925CrossRef

20.

Ryu CH, Lee SK (2011) Biliary strictures after liver transplantation. Gut Liver 5(2):133–142

21.

Kochhar G, Parungao JM, Hanouneh IA, Parsi MA (2013) Biliary complications following liver transplantation. World J Gastroenterol 19(19):2841–2846

Title: Endoscopic ultrasound: valuable tool for diagnosis of biliary complications in liver transplant recipients?
Authors: Anna Hüsing
Vito R. Cicinnati
Susanne Beckebaum
Christian Wilms
Hartmut H. Schmidt
Iyad Kabar
Publication date: 01-06-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3820-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic ultrasound: valuable tool for diagnosis of biliary complications in liver transplant recipients?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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