Endoscopic management of high-grade biliary strictures complicating living donor liver transplantation using soehendra stent retrievers

Abstract

Background

Biliary strictures following living donor liver transplantation (LDLT) are usually managed by endoscopic retrograde cholangiography (ERC) with stricture dilation and stent placement. While current endoscopic techniques are successful in most cases, high-grade biliary strictures (HGBS) pose a challenge using currently employed techniques which have a low rate of technical success.

Aims

In this study, we have explored the safety and efficacy of Soehendra stent retrievers (SSR) for the dilation of HGBS complicating LDLT.

Methods

This was a prospective cohort study where all patients with anastomotic biliary strictures following LDLT from January 2016 till February 2018 were included. Patients with HGBS defined as the exclusive passage of 0.018-inch guidewire, were included in Group 1. In these patients, 5 Fr Soehendra stent retrievers were used to dilate HGBS over guidewire, using torsional movements. Technical success, safety and clinical response was compared with patients who required Per-cutaneous transhepatic cholangiography (PTC) with rendezvous procedure due to a failed ERC, before the commencement of the study (Group 2).

Results

Ten patients with HGBS were included into Group 1. Technical success defined as successful placement of a biliary stent across the stricture was achieved in all the patients in group 1. Favorable response to endotherapy was higher in group 1(8/10 patients (80%)) as compared to group 2(6/14 patients (42.8%)). There were no post procedure complications in patients of group 1, while 3 patients developed cholangitis in group 2.

Conclusions

HGBS can be successfully treated with SSR for stricture dilation. It is safe with no significant complications and requires fewer procedures.

Keywords:

• Soehendra
• biliary stricture
• liver transplant
• endoscopy

Institutional review board

The study was reviewed and approved by the Amrita Institute of Medical sciences Research Review Board (Kochi, Kerala, India).

Author contributions

Priya Nair and Krishna Priya helped in subject recruitment and data entry of the study. Harshavardhan Rao B and Anoop Koshy were involved with data analysis and interpretation. Harshavardhan Rao B drafted the manuscript; Rama P Venu and Sudhindran S, revised the article critically for important intellectual content.

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

This is an original work with no financial support/grants received.