Current management of biliary complications after liver transplantation: Emphasis on endoscopic therapy

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• 作者：Domingo Balderramo^a ; ^c ; Miguel Navasa^b ; ^c ; Andres Cardenas^a ; ^c ; ^{acardena@clinic.ub.es}
• 关键词：Endoscopic retrograde cholangiography ; Liver transplantation ; Biliary strictures ; Bile leak ; Living donor liver transplantation
• 刊名：Gastroenterolog¨ªa y Hepatolog¨ªa
• 出版年：2011
• 出版时间：February 2011
• 年：2011
• 卷：34
• 期：2
• 页码：107-115
• 全文大小：403 K

文摘

Biliary complications occur in 5?5 % of patients after liver transplantation and represent a major source of morbidity in this group of individuals. The major risk factor for most of these complications is ischemia of the bile tree usually due to obstruction or vascular insufficiency of the hepatic artery. The most common complications include biliary strictures (anastomostic and nonanastomotic), bile leaks, and biliary filling defects. The initial diagnostic approach starts with a high index of suspicion along with an abdominal ultrasound and Doppler exam. Magnetic resonance imaging is highly sensitive and is usually reserved for confirmation. The vast majority of these complications can be successfully treated with endoscopic retrograde cholangiography, however if this procedure cannot be performed a percutaneous approach or surgery is recommended. Nonanastomotic strictures and living donor recipients present a less favorable response to endoscopic management. This review focuses on the current diagnostic and therapeutic approaches for the management of biliary complications after liver transplantation.