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Updated: Apr 19, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Endoscopic treatment of pediatric post-transplant biliary complications is safe and effective
Alexander Dechêne1, Cathrin Kodde1, Simone Kathemann2
1Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
Insights
Endoscopic retrograde cholangiopancreaticography (ERCP) offers a safe and effective treatment for biliary complications (BC) in pediatric liver transplant (LT) recipients when the bile duct is accessible. This study highlights ERCP
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Transplant Surgery
Background:
- Biliary complications (BC) are frequent and serious after liver transplantation (LT), occurring in over 10% of pediatric cases.
- While endoscopic retrograde cholangiopancreaticography (ERCP) is effective in adults, data on its use in pediatric LT recipients are limited.
- This study analyzes the outcomes of endoscopic treatment for BC in a German pediatric LT cohort.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreaticography (ERCP) for treating biliary complications (BC) in pediatric liver transplant (LT) patients.
- To identify the types and frequency of BC encountered in this cohort.
- To assess the success rates of endoscopic interventions.
Main Methods:
- Retrospective analysis of pediatric LT recipients (<18 years) treated for BC at University Hospital Essen.
- Evaluation of liver transplant characteristics, endoscopic procedures, BC presentation, and outcomes.
- Data collected included type of graft, bile duct access, and specific endoscopic interventions performed.
Main Results:
- Seventeen pediatric patients (median age 12 years) underwent ERCP for BC.
- The most common BC were biliary anastomosis stricture (AST) (11 patients), biliary cast syndrome (BCS) (5 patients), and ischemia-type biliary lesions (ITBL) (2 patients).
- Endoscopic treatment was successful in cases where the biliary tract was accessible via ERCP.
Conclusions:
- Endoscopic retrograde cholangiopancreaticography (ERCP) is a safe and effective treatment modality for biliary complications (BC) in pediatric liver transplant (LT) recipients.
- Accessible biliary tracts facilitate successful endoscopic intervention.
- Anastomotic strictures, biliary cast syndrome, and ischemia-type biliary lesions are the primary BCs managed endoscopically in this population.
Background And Aim:
Biliary complications (BC) after liver transplantation (LT) are associated with significant morbidity and mortality. Incidence of BC after pediatric LT is more than 10%. In adults, treatment by endoscopic retrograde cholangiopancreaticography (ERCP) is successful. As data in pediatric patients are limited, endoscopic treatment of BC in a pediatric cohort in a German transplant center was analyzed.
Methods:
LT recipients <18 years of age who were endoscopically treated for BC at University Hospital Essen were retrospectively analyzed. Characteristics of LT, endoscopic treatment measures, clinical and endoscopic presentation of BC, and outcomes after endoscopic treatment were evaluated.
Results:
Seventeen patients (median age 12 years) with clinical signs of BC were treated endoscopically using ERCP. Eleven patients had received a full-size liver, and six a left-sided living-donor transplant graft. In 12 patients, the bile ducts were accessible via Vater's papilla and five patients had a bilioenteric anastomosis. Biliary sphincterotomy was done in 13 patients. Eleven patients presented with stricture of the biliary anastomosis (AST), either isolated (nine) or in combination with biliary cast syndrome (BCS) or biliary leakage (one patient each). Ischemia-type biliary lesions (ITBL) were found in two patients. Five patients suffered from BCS, either as isolated pathology (two) or in combination with AST, bile leak or ITBL. In one patient, biliary access via the major papilla was not obtainable.
Conclusions:
BC in pediatric LT were treated safely and successfully in pediatric patients when the biliary tract was accessible. The most common complications were AST, BCS and ITBL.
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