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Single-operator cholangioscopy for biliary complications in liver transplant recipients

World Journal of Gastroenterology 2017年第22期23卷 4064-4071页

作者： Anna Hüsing-Kabar Hauke Sebastian Heinzow Hartmut Hans-Jürgen Schmidt Carina Stenger Hans Ulrich Gerth Michele Pohlen gerold tholking Christian Wilms Iyad Kabar Department of Transplant Medicine University Hospital Muenster Department of Medicine D Division of General Internal MedicineNephrology and RheumatologyUniversity Hospital Muenster Department of Medicine A Hematology and OncologyUniversity Hospital Muenster

To evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT).METHODSTwenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between April and December 2016 at the university hospital of Muenster were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation. All patients received peri-interventional antibiotic prophylaxis and bile was collected during the intervention for microbial analysis and for antibiotic susceptibility ***-three biliary complications were found in a total of 22 patients, whereas four patients showed normal bile ducts. Anastomotic strictures were evident in 14 (53.8%) patients, non-anastomotic strictures in seven (26.9%), biliary cast in three (11.5%), and stones in six (23.1%). A benefit of cholangioscopy was seen in 12 (46.2%) patients. In four of them, cholangioscopy was crucial for selective guidewire placement prior to planned intervention. In six patients, biliary cast and/or stones failed to be diagnosed by ERCP and were only detectable through cholangioscopy. In one case, a bile duct ulcer due to fungal infection was diagnosed by cholangioscopy. In another case, signs of bile duct inflammation caused by acute cholangitis were evident. One patient developed post-interventional cholangitis. No further procedure-related complications occurred. Thirty-seven isolates were found in bile. Sixteen of these were gram-positive (43.2%), 12 (32.4%) were gram-negative bacteria, and Candida species accounted for 24.3% of all isolated microorganisms. Interestingly, only 48.6% of specimens were sensitive to prophylactic ***-operator c

关键词： Cholangioscopy Endoscopic retrograde cholangiopancreatography Liver transplantation Biliary complications Biliary strictures

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