Digital single-operator cholangioscopy for biliary stricture after cadaveric liver transplantation

Area of Science:

• Gastroenterology
• Hepatology
• Surgical Innovation

Background:

• Biliary strictures post-liver transplantation (LT) present significant clinical challenges.
• Endoscopic retrograde cholangiopancreatography (ERCP) is standard but shows variable success in LT biliary strictures.
• Digital single-operator peroral cholangioscopy (DSOC) offers potential for indeterminate biliary strictures.

Purpose of the Study:

• To evaluate the utility of DSOC combined with ERCP for managing biliary strictures following LT.
• Assess DSOC's diagnostic and therapeutic contribution in complex post-transplant biliary cases.

Main Methods:

• An observational study of 19 patients with duct-to-duct biliary reconstruction undergoing ERCP for suspected complications.
• DSOC was performed using the SpyGlass DS™ system during ERCP under conscious sedation.
• Biliary strictures were classified based on choledochoscopic and transplanted duct manifestations.

Main Results:

• Twenty-one strictures were identified in 19 patients; 94.7% were anastomotic.
• DSOC identified stones (57.9%) and loose sutures (42.1%) missed by ERCP in 9 patients.
• Cholangioscopy facilitated guidewire placement in 4 patients and diagnosed a space-occupying lesion in 1.

Conclusions:

• DSOC provides valuable diagnostic insights for LT-related biliary strictures.
• It aids in planning and executing interventions, improving management of complex cases.
• DSOC enhances the diagnostic capability during ERCP for post-liver transplant biliary complications.