Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasmus Hospital, ULB (Free University of Brussels), Brussels, Belgium.
Department of Radiology, CUB Erasmus Hospital, ULB (Free University of Brussels), Brussels, Belgium.
J Gastroenterol Hepatol. 2021 May;36(5):1366-1377. doi: 10.1111/jgh.15318. Epub 2020 Nov 10.
The aim of this study is to describe the cholangiographic features and endoscopic management of biliary cast syndrome (BCS), a rare specific ischemic cholangiopathy following liver transplantation.
Patients with biliary complications were identified from prospectively collected database records of patients who underwent liver transplantation at the Erasme Hospital from January 2005 to December 2014. After excluding patients with hepatico-jejunostomy or no suspicion of stricture, cholangiograms obtained during endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance imaging were systematically reviewed. Biliary complications were categorized as anastomotic (AS) and non-AS strictures, and patients with BCS were identified. Clinical, radiological, and endoscopic data were reviewed.
Out of 311 liver transplantations, 14 cases were identified with BCS (4.5%) and treated with ERCP. Intraductal hyperintense signal on T1-weighted magnetic resonance and a "duct-in-a-duct" image were the most frequent features of BCS on magnetic resonance imaging. On initial ERCP, 57% of patients had no stricture. Complete cast extraction was achieved in 12/14, and one of these had cast recurrence. On follow-up, 85% of the patients developed biliary strictures that were treated with multiple plastic stents reaching 60% complete stricture resolution, but 40% of them had recurrence. After a median follow-up of 58 months, BCS patients had lower overall and graft survival (42.9% and 42.9%) compared with non-AS (68.8% and 56.3%) and AS (83.3% and 80.6%), respectively.
Particular magnetic resonance-cholangiographic and ERCP-cholangiographic features of BCS have been identified. Outcomes for BCS are characterized by high complete cast extraction rates, high incidence of secondary strictures, and poorer prognosis.
本研究旨在描述胆系铸型综合征（BCS）的胆系造影特征和内镜治疗，BCS 是肝移植后一种罕见的特定缺血性胆管病。
从 2005 年 1 月至 2014 年 12 月在 Erasme 医院接受肝移植的患者前瞻性收集的数据库记录中确定患有胆系并发症的患者。排除行胆肠吻合术或无狭窄怀疑的患者后，系统回顾内镜逆行胰胆管造影（ERCP）和磁共振成像获得的胆系造影。将胆系并发症分为吻合口（AS）和非 AS 狭窄，并确定 BCS 患者。回顾临床、放射学和内镜数据。
在 311 例肝移植中，发现 14 例 BCS（4.5%）并接受 ERCP 治疗。磁共振成像上 BCS 最常见的特征是 T1 加权磁共振上的管内高信号和“管内胆管”图像。在初始 ERCP 中，57%的患者没有狭窄。14 例患者中有 12 例完全取出铸型，其中 1 例复发。随访时，85%的患者出现胆系狭窄，接受了多个塑料支架治疗，达到 60%的完全狭窄缓解，但其中 40%的患者复发。中位随访 58 个月后，BCS 患者的总体和移植物存活率均低于非 AS（分别为 42.9%和 42.9%）和 AS（分别为 83.3%和 80.6%）。
已确定 BCS 的特殊磁共振胆系成像和 ERCP 胆系成像特征。BCS 的结果特征为完全铸型提取率高、继发性狭窄发生率高和预后较差。
