Korean J Radiol.  2012 Apr;13(2):189-194. 10.3348/kjr.2012.13.2.189.

Alternative Techniques for Cannulation of Biliary Strictures Resistant to the 0.035" System Following Living Donor Liver Transplantation

• Yoon HM
• Kim JH
• Ko GY
• Song HY
• Gwon DI
• Sung KB

• KMID: 1245383
• DOI: http://doi.org/10.3348/kjr.2012.13.2.189

Abstract

OBJECTIVE
To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique.
SUBJECTS AND METHODS
Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches.
RESULTS
Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision.
CONCLUSION
Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.

Keyword

Living donor liver transplantation; Biliary complications; Endoscopy; Fluoroscopy

MeSH Terms

Adult
Bile Ducts/*surgery
Catheterization/*methods
Constriction, Pathologic
Female
Fluoroscopy
Humans
*Liver Transplantation
*Living Donors
Male
Middle Aged
Reoperation
Treatment Outcome

Figure

• 

  Fig. 1 Schematic drawings of two alternative techniques. A. Technique using microcatheter set (arrow head). B. Technique using snare (rendezvous technique). Guide wire was inserted into stricture through endoscopic nasobiliary drainage catheter (arrowhead), while snare (arrow) was introduced through percutaneous transhepatic biliary drainage catheter. Snare was used to capture guide wire and pull it through stricture to complete cannulation of stricture.

• 

  Fig. 2 Technique using microcatheter set in 56-year-old man with stricture in duct to duct anastomosis following right-lobe living donor liver transplantation. A. Cholangiogram showing severe, twisted stricture (arrow) in duct-to-duct anastomosis. Due to severity of stricture, cannulation failed using conventional technique. B. Cholangiogram showing successful cannulation of stricture using microcatheter set (arrowhead).

• 

  Fig. 3 Technique using snare (rendezvous technique) in 46-year-old woman with stricture in duct to duct anastomosis following right-lobe living donor liver transplantation. A. Cholangiogram showing severe stricture (arrow) at duct-to-duct anastomosis. B, C. View showing introduction of guide wire through endoscopic nasobiliary drainage tube (arrowhead) and capture of guide wire by snare (arrows). Guide wire was subsequently pulled through stricture to complete its cannulation. D. After successful cannulation and subsequent balloon dilation of stricture, percutaneous transhepatic biliary drainage tube (arrow) was advanced across stricture.

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