Ng Jonathan, Chandran Sujievvan, Be Kim Hay, Zorron Cheng Tao Pu Leonardo, Choi Kevin Kyung Ho, Saxena Payal, Kaffes Arthur John, Vaughan Rhys, Efthymiou Marios
Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia.
Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne Victoria Australia.
JGH Open. 2024 Oct 8;8(10):e13112. doi: 10.1002/jgh3.13112. eCollection 2024 Oct.
Strictures are the most common biliary complication after liver transplantation, and endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard in its management. Failure to cross the biliary anastomosis requires a repeated attempt with ERCP, referral for percutaneous transhepatic cholangiography (PTC) or surgery. We present our experience with the digital single operator cholangioscope (D-SOC) in achieving guidewire access in a liver transplant cohort with difficult biliary strictures who have failed conventional ERCP methods.
This was a retrospective study involving two adult liver transplant centers servicing the two most populated states in Australia. Deceased-donor liver transplant recipients undergoing D-SOC for biliary strictures who have failed conventional methods to achieve biliary access were included.
Between July 2017 to April 2022, eighteen patients underwent D-SOC after failing to achieve guidewire placement through standard ERCP techniques. Thirteen out of eighteen (72%) had successful guidewire placement with index D-SOC. Five of eighteen patients (28%) had unsuccessful guidewire placement with D-SOC. In two of these patients, use of D-SOC informed further endoscopic management, with one avoiding PTC and the other avoiding surgery. Two of the five patients required PTC and one patient was left unstented. Three patients developed post D-SOC cholangitis.
D-SOC is effective at achieving guidewire access in post-liver transplant patients who fail conventional ERCP techniques and should be considered in the treatment algorithm as a step before PTC and surgery.
狭窄是肝移植后最常见的胆道并发症，内镜逆行胰胆管造影术（ERCP）被认为是其治疗的金标准。无法通过胆道吻合口时，需要重复进行ERCP尝试、转诊进行经皮经肝胆管造影术（PTC）或手术。我们介绍了我们使用数字单操作者胆管镜（D-SOC）在一组肝移植患者中实现导丝进入的经验，这些患者存在难治性胆道狭窄且常规ERCP方法失败。
这是一项回顾性研究，涉及澳大利亚两个人口最多的州的两个成人肝移植中心。纳入了因胆道狭窄接受D-SOC治疗且常规方法未能实现胆道通路的已故供体肝移植受者。
在2017年7月至2022年4月期间，18例患者在通过标准ERCP技术未能成功放置导丝后接受了D-SOC治疗。18例中的13例（72%）在首次D-SOC操作时成功放置了导丝。18例患者中有5例（28%）使用D-SOC未能成功放置导丝。在其中2例患者中，D-SOC的使用为进一步的内镜治疗提供了信息，1例避免了PTC，另1例避免了手术。5例患者中有2例需要进行PTC，1例患者未放置支架。3例患者发生了D-SOC术后胆管炎。
D-SOC在常规ERCP技术失败的肝移植术后患者中实现导丝进入方面是有效的，应在治疗方案中作为PTC和手术之前的一个步骤予以考虑。
