Part of the research reported in this article was funded by an Emili Letang grant from the Hospital Clinic in Barcelona.
Prospective Evaluation of Single-Operator Peroral Cholangioscopy in Liver Transplant Recipients Requiring an Evaluation of the Biliary Tract
Article first published online: 12 FEB 2013
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 19, Issue 2, pages 199–206, February 2013
How to Cite
Balderramo, D., Sendino, O., Miquel, R., de Miguel, C. R., Bordas, J. M., Martinez-Palli, G., Leoz, M. L., Rimola, A., Navasa, M., Llach, J. and Cardenas, A. (2013), Prospective Evaluation of Single-Operator Peroral Cholangioscopy in Liver Transplant Recipients Requiring an Evaluation of the Biliary Tract. Liver Transpl, 19: 199–206. doi: 10.1002/lt.23585
- Issue published online: 12 FEB 2013
- Article first published online: 12 FEB 2013
- Manuscript Accepted: 23 OCT 2012
- Manuscript Received: 31 JUL 2012
In this descriptive study, we examined the role of single-operator cholangioscopy (SOC) in the evaluation of biliary complications after liver transplantation (LT). We prospectively included adult recipients of deceased donor LT who were referred for endoscopic retrograde cholangiopancreatography between June 2009 and July 2011. All patients underwent SOC with biopsy of the biliary anastomosis. Sixteen patients were included: 12 with biliary anastomotic strictures (ASs), 2 with common bile duct stones, 1 with a bile leak, and 1 with sphincter of Oddi dysfunction. Patients with ASs displayed 1 of 2 patterns: (A) mild erythema (n = 9) or (B) edema, ulceration, and sloughing (n = 3). Those without ASs displayed a pale mucosa with mild edema at the anastomosis. Patients with ASs and pattern B required a longer period of stenting than patients with pattern A (457 versus 167 days, P = 0.01). In addition, patients with pattern A had a better response and better resolution of their strictures with endoscopic therapy than those with pattern B (88.9% versus 33.4%, P = 0.13). Histological examinations of ASs showed nonspecific intraepithelial inflammation in patients with patterns A and B. Biopsy samples from patients without ASs showed normal columnar epithelial bile duct cells. The total cholangioscopy time for all procedures was 26.8 ± 10.1 minutes. In conclusion, SOC in LT recipients is feasible and allows adequate visualization and tissue sampling of ASs and bile ducts. Two distinct visual patterns that are easily identified with SOC may help to predict the outcomes of endoscopic therapy in patients with biliary complications after LT. Liver Transpl 19:199-206, 2013. © 2012 AASLD.