Endoscopic treatment of pediatric post‐transplant biliary complications is safe and effective. Issue 4 (4th February 2015)

• Record Type: Journal Article
• Authors: Dechêne, Alexander; Kodde, Cathrin; Kathemann, Simone; Treckmann, Jürgen; Lainka, Elke; Paul, Andreas; Gerken, Guido; Feldstein, Ariel E.; Hoyer, Peter F.; Canbay, Ali
• Is Part Of: Digestive endoscopy. Volume 27:Issue 4(2015)
• Page Start: 505
• Page End: 511
• Publication Date: 2015-02-04
• Subjects: Digestive organs -- Diseases -- Periodicals; Digestive organs -- Diseases -- Diagnosis -- Periodicals; Endoscopy -- Periodicals; Digestive System Diseases -- diagnosis -- Periodicals; Digestive System Diseases -- therapy -- Periodicals; Endoscopy -- Periodicals; 616.3
• DOI: 10.1111/den.12420
• Languages: English
• ISSNs: 0915-5635

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="den12420-sec-0001" sec-type="section"> <title>Background and Aim</title> <p>Biliary complications (BC) after liver transplantation (LT) are associated with significant morbidity and mortality. Incidence of BC after pediatric LT is more than 10%. In adults, treatment by endoscopic retrograde cholangiopancreaticography (ERCP) is successful. As data in pediatric patients are limited, endoscopic treatment of BC in a pediatric cohort in a German transplant center was analyzed.</p> </sec> <sec id="den12420-sec-0002" sec-type="section"> <title>Methods</title> <p>LT recipients <18 years of age who were endoscopically treated for BC at University Hospital Essen were retrospectively analyzed. Characteristics of LT, endoscopic treatment measures, clinical and endoscopic presentation of BC, and outcomes after endoscopic treatment were evaluated.</p> </sec> <sec id="den12420-sec-0003" sec-type="section"> <title>Results</title> <p>Seventeen patients (median age 12 years) with clinical signs of BC were treated endoscopically using ERCP. Eleven patients had received a full‐size liver, and six a left‐sided living‐donor transplant graft. In 12 patients, the bile ducts were accessible via Vater's papilla and five patients had a bilioenteric anastomosis. Biliary sphincterotomy was done in 13 patients. Eleven patients presented with stricture of the biliary anastomosis (AST), either isolated (nine) or in combination with biliary cast syndrome (BCS) or biliary leakage (one patient each). Ischemia‐type biliary lesions (ITBL) were found in two patients. Five patients suffered from BCS, either as isolated pathology (two) or in combination with AST, bile leak or ITBL. In one patient, biliary access via the major papilla was not obtainable.</p> </sec> <sec id="den12420-sec-0004" sec-type="section"> <title>Conclusions</title> <p>BC in pediatric LT were treated safely and successfully in pediatric patients when the biliary tract was accessible. The most common complications were AST, BCS and ITBL.</p> </sec> </abstract>