Pediatric biliary interventions

Area of Science:

• Pediatric Hepatology
• Interventional Radiology
• Transplant Surgery

Background:

• Liver transplant complications, such as biliary strictures and leaks, are common in children.
• Roux-en-Y biliary-enteric anastomosis in pediatric liver transplants precludes endoscopic retrograde cholangiopancreatography.
• Percutaneous transhepatic cholangiography (PTC) is the preferred initial approach for biliary evaluation and intervention in this population.

Purpose of the Study:

• To evaluate the efficacy and challenges of percutaneous biliary intervention in pediatric liver transplant recipients.
• To establish PTC as a first-line treatment for biliary obstruction in pediatric liver transplant patients.
• To compare the outcomes of percutaneous biliary intervention in children with those in adults.

Main Methods:

• Utilizing ultrasound guidance for percutaneous transhepatic cholangiography (PTC) and biliary interventions.
• Managing biliary obstruction and stenosis through percutaneous drainage and balloon dilation (cholangioplasty).
• Performing repeat procedures, including cholangioplasties and catheter exchanges, as needed for long-term management.

Main Results:

• Technical success rates for PTC and biliary drainage in children are comparable to adults, despite potential challenges like minimal ductal dilation.
• Percutaneous biliary intervention requires a long-term commitment, often spanning months to over a year.
• The procedure demonstrates a low morbidity and mortality rate compared to open surgical options.

Conclusions:

• Percutaneous biliary intervention, primarily PTC, is a safe and effective first-line treatment for biliary stenosis in pediatric liver transplant recipients.
• This minimally invasive approach is also recommended for non-transplant pediatric patients unsuitable for endoscopic treatment.
• Long-term management of biliary complications post-liver transplant necessitates a dedicated, often prolonged, interventional radiology strategy.