Double-balloon enteroscopy for bilioenteric anastomotic stricture after pediatric living donor liver transplantation
Yukihiro Sanada1, Koichi Mizuta, Tomonori Yano
1Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan. yuki371@jichi.ac.jp
Insights
Double-balloon enteroscopy (DBE) offers a safe and effective method for managing bilioenteric anastomotic strictures after pediatric liver transplants. Type II strictures and longer cold ischemic times are identified as risk factors for intractable cases.
Area of Science:
- Gastroenterology
- Transplant Surgery
- Pediatric Surgery
Background:
- Bilioenteric anastomotic stricture is a common complication following liver transplantation, necessitating effective early detection and management strategies.
- Pediatric living donor liver transplantation (LDLT) presents unique challenges in managing anastomotic complications.
Purpose of the Study:
- To evaluate the efficacy and safety of double-balloon enteroscopy (DBE) in managing bilioenteric anastomotic strictures after pediatric LDLT.
- To identify factors associated with intractable strictures.
Main Methods:
- A retrospective study of 25 pediatric patients undergoing DBE for bilioenteric anastomotic stricture post-LDLT between May 2003 and July 2009.
- Classification of strictures into Type I (dilatation ≥5x) and Type II (dilatation <5x) based on pre- and post-interventional radiology (IVR) findings.
- Assessment of DBE reach and IVR success rates.
Main Results:
- DBE successfully reached the anastomotic site in 68.0% (17/25) of patients.
- Interventional radiology (IVR) was successful in 88.2% (15/17) of cases where DBE reached the site.
- Type II strictures (n=12) were associated with significantly longer cold ischemic times (P=0.005) and higher recurrence rates (P=0.006) compared to Type I (n=3).
Conclusions:
- DBE is a safe, less invasive treatment option for bilioenteric anastomotic strictures after pediatric LDLT, facilitating IVR.
- Type II strictures and prolonged cold ischemic time are significant risk factors for intractable anastomotic strictures, indicating a need for closer monitoring and tailored management.
Abstract:
Bilioenteric anastomotic stricture after liver transplantation is still frequent and early detection and treatment is important. We established the management using double-balloon enteroscopy (DBE) and evaluated the intractability for bilioenteric anastomotic stricture after pediatric living donor liver transplantation (LDLT). We underwent DBE at Jichi Medical University from May 2003 to July 2009 for 25 patients who developed bilioenteric anastomotic stricture after pediatric LDLT. The patients were divided into two types according to the degree of dilatation of the anastomotic sites before and after interventional radiology (IVR) using DBE. Type I is an anastomotic site macroscopically dilated to five times or more, and Type II is an anastomotic site dilated to less than five times. The rate of DBE reaching the bilioenteric anastomotic sites was 68.0% (17/25), and the success rate of IVR was 88.2% (15/17). There were three cases of Type I and 12 cases of Type II. Type II had a significantly longer cold ischemic time and higher recurrence rate than Type I (P = 0.005 and P = 0.006). In conclusion, DBE is a less invasive and safe treatment method that is capable of reaching the bilioenteric anastomotic site after pediatric LDLT and enables IVR to be performed on strictures, and its treatment outcomes are improving. Type II and long cold ischemic time are risk factors for intractable bilioenteric anastomotic stricture.