Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A...

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Interventional radiology

Background:

• Liver transplant recipients frequently experience biliary complications, necessitating effective management strategies.
• Percutaneous access to the biliary system is crucial for diagnosing and treating these complications.
• The modified Hutson loop access (MHLA) provides a potential route for biliary interventions.

Purpose of the Study:

• To present institutional experience and algorithm for biliary interventions using MHLA in liver transplant patients.
• To evaluate the impact of percutaneous endoscopy via MHLA on procedural success and outcomes.

Main Methods:

• A retrospective review of 201 MHLA procedures performed on 52 liver transplant patients over 13 years.
• Procedures included diagnostic (cholangiography) and therapeutic interventions (stenting, cholangioplasty) for biliary strictures and leaks.
• Percutaneous endoscopy was utilized in 69% of procedures to visualize the biliary-enteric anastomosis and aid in biliary hygiene.

Main Results:

• Overall technical success rate was 95% (190/201).
• Procedures with percutaneous endoscopy showed significantly higher success rates (98% vs. 87%) and reduced need for new transhepatic access (12% vs. 30%).
• Major adverse events occurred in 1% of procedures, with no procedure-related mortality.

Conclusions:

• MHLA-based percutaneous biliary intervention is a safe and effective method for managing post-liver transplant biliary complications.
• Incorporating percutaneous endoscopy via MHLA enhances procedural success rates and minimizes the requirement for additional transhepatic access.
• This approach represents a valuable alternative for complex biliary management in liver transplant recipients.