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World J Gastrointest Endosc. May 16, 2015; 7(5): 446-459
Published online May 16, 2015. doi: 10.4253/wjge.v7.i5.446
Endoscopic management of post-liver transplant biliary complications
Mohit Girotra, Kaartik Soota, Jagpal S Klair, Shyam M Dang, Farshad Aduli
Mohit Girotra, Kaartik Soota, Jagpal S Klair, Shyam M Dang, Farshad Aduli, Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Author contributions: Girotra M contributed to literature search, preparation of manuscript, proof-reading, final approval; Soota K and Klair JS contributed to literature search, preparation of manuscript; Dang SM and Aduli F contributed to proof-reading, final approval.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mohit Girotra, MD, FACP, Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Shorey S8-68, Slot # 567, Little Rock, AR 72205, United States. mgirotra@uams.edu
Telephone: +1-501-6865175 Fax: +1-501-6866248
Received: September 30, 2014
Peer-review started: October 1, 2014
First decision: October 28, 2014
Revised: November 15, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 16, 2015
Processing time: 230 Days and 2.3 Hours
Abstract

Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques that have proved endoscopic retrograde cholangiography with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also discuss the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality.

Keywords: Liver transplant; Biliary; Complications; Strictures; Bile leak; Management; Endoscopy; Endoscopic retrograde cholangiography; Biloma; Stone; Cast

Core tip: Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques which have proved ERCP with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also deliberate the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality.