Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2022; 14(5): 1037-1049
Published online May 15, 2022. doi: 10.4251/wjgo.v14.i5.1037
Digital single-operator cholangioscopy for biliary stricture after cadaveric liver transplantation
Jian-Feng Yu, Dong-Lei Zhang, Yan-Bin Wang, Jian-Yu Hao
Jian-Feng Yu, Dong-Lei Zhang, Yan-Bin Wang, Jian-Yu Hao, Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Hao JY provided supervision, guidance, and constant encouragement during the study and during the writing; Wang YB contributed to the study concept and design; Zhang DL contributed to the drafting of the manuscript; four colleagues (Lang R, Fan H, Liu Y, and Li LX) from Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University contributed to data collection; Yu JF contributed to the revision of the manuscript; and all authors approved the final version of the report.
Institutional review board statement: The present study was approved by the Ethics Committee of Chao-Yang Hospital (Approval number: 2020-25).
Informed consent statement: Written informed consent was obtained from the patients.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Yu Hao, MD, PhD, Chief Physician, Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing 100020, China. haojianyuxhnk@sina.cn
Received: December 20, 2021
Peer-review started: December 20, 2021
First decision: February 21, 2022
Revised: April 8, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: May 15, 2022
Processing time: 140 Days and 23 Hours
Abstract
BACKGROUND

Biliary strictures after liver transplantation (LT) remain clinically arduous and challenging situations, and endoscopic retrograde cholangiopancreatography (ERCP) has been considered as the gold standard for the management of biliary strictures after LT. Nevertheless, in the treatment of biliary strictures after LT with ERCP, many studies show that there is a large variation in diagnostic accuracy and therapeutic success rate. Digital single-operator peroral cholangioscopy (DSOC) is considered a valuable diagnostic modality for indeterminate biliary strictures.

AIM

To evaluate DSOC in addition to ERCP for management of biliary strictures after LT.

METHODS

Nineteen patients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between March 2019 and March 2020 at Beijing Chaoyang Hospital, Capital Medical University, were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation. All patients received peri-interventional antibiotic prophylaxis. Biliary strictures after LT were classified according to the manifestations of choledochoscopic strictures and the manifestations of transplanted hepatobiliary ducts.

RESULTS

Twenty-one biliary strictures were found in a total of 19 patients, among which anastomotic strictures were evident in 18 (94.7%) patients, while non-anastomotic strictures in 2 (10.5%), and space-occupying lesions in 1 (5.3%). Stones were found in 11 (57.9%) and loose sutures in 8 (42.1%). A benefit of cholangioscopy was seen in 15 (78.9%) patients. Cholangioscopy was crucial for selective guidewire placement prior to planned intervention in 4 patients. It was instrumental in identifying biliary stone and/or loose sutures in 9 patients in whom ERCP failed. It also provided a direct vision for laser lithotripsy. A space-occupying lesion in the bile duct was diagnosed by cholangioscopy in one patient. Patients with biliary stricture after LT displayed four types: (A) mild inflammatory change (n = 9); (B) acute inflammatory change edema, ulceration, and sloughing (n = 3); (C) chronic inflammatory change; and (D) acute suppurative change. Complications were seen in three patients with post-interventional cholangitis and another three with hyperamylasemia.

CONCLUSION

DSOC can provide important diagnostic information, helping plan and perform interventional procedures in LT-related biliary strictures.

Keywords: Cholangioscopy; Endoscopic retrograde cholangiopancreatography; Liver transplantation; Biliary strictures; Biliary complications; Biliary anastomotic stricture

Core Tip: Biliary strictures represent a leading cause of morbidity and mortality in liver transplant recipients. To date, endoscopic retrograde cholangiopancreatography remains the gold standard for diagnosing and treating such complications. The present study examined the benefit of complementary digital single-operator cholangioscopy. Our results are encouraging and demonstrate strong evidence for a diagnostic and therapeutic advantage of additional cholangioscopy for the management of biliary disorders following liver transplantation.