[Endoscopic management of biliary complications after liver transplantation]

Biliary complications are common in liver transplant recipients and may develop in up to one-third of all patients. Bile leaks generally occur within the first 3 months and are frequently related to T-tube removal. The recent trend to avoid of T-tubes has probably resulted in a reduced incidence of such bile leaks. The other major biliary complications in liver transplant recipients include biliary strictures, choledocholithiasis, biliary casts and sphincter of Oddi dysfunction. Biliary strictures can be classified into anastomotic and non-anastomotic strictures. Anastomotic strictures are generally related to technical complications of choledochocholedochostomy, while non-anastomotic strictures are frequently related to hepatic artery thrombosis. The overwhelming majority of biliary complications choledochocholedochostomy can be managed by endoscopic means, ranging from use of plastic stents, balloon dilation or endoscopic sphincteromoty. Surgical revision may be required in rare instances such as recurrent biliary casts or large caliber leaks associated with anastomotic strictures. The purpose of this review is to review the incidence, risk factors for and pathogenesis of biliary complications after liver transplantation. The results of endoscopic management of these strictures is also described in detail and should be of interest to therapeutic endoscopists, liver transplant physicians, transplant surgeons and therapeutic endoscopists.