Cutting balloon treatment of anastomotic biliary stenosis after liver transplantation: Report of two cases

doi:10.3748/wjg.v23.i1.178

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World Journal of Gastroenterology

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Case Report

World J Gastroenterol. Jan 7, 2017; 23(1): 178-184
Published online Jan 7, 2017. doi: 10.3748/wjg.v23.i1.178

Cutting balloon treatment of anastomotic biliary stenosis after liver transplantation: Report of two cases

Fan Ding, Hui Tang, Chi Xu, Zai-Bo Jiang, Shu-Hong Yi, Hua Li, Nan Jiang, Wen-Jie Chen, Qing Yang, Yang Yang, Gui-Hua Chen

Fan Ding, Hui Tang, Chi Xu, Shu-Hong Yi, Hua Li, Nan Jiang, Qing Yang, Yang Yang, Gui-Hua Chen, Department of Hepatic Surgery and Liver Transplantation Center of The Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China

Fan Ding, Hui Tang, Chi Xu, Shu-Hong Yi, Hua Li, Nan Jiang, Qing Yang, Yang Yang, Gui-Hua Chen, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China

Zai-Bo Jiang, Department of Vascular and Interventional Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China

Wen-Jie Chen, Yang Yang, Gui-Hua Chen, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China

Author contributions: Ding F, Xu C, Yang Y and Chen GH designed the report; Jiang ZB performed the cutting balloon treatment; Jiang N, Yang Q, Yang Y and Chen GH performed the orthotopic liver transplantation; Ding F, Tang H and Chen WJ collected the patients’ clinical data; Ding F, Tang H, Xu C, Yi SH and Li H analyzed the data and wrote the paper.

Supported by Key Scientific and Technological Projects of Guangdong Province, No. 2014B020228003, No. 2014B030301041 and No. 2015B020226004; the Natural Science Foundation of Guangdong Province, No. 2015A030312013; and the Science and Technology Planning Project of Guangzhou, No. 201400000001-3 and No. 158100076.

Institutional review board statement: This case report was exempt from Institutional Review Board review [(2016)2-114] at The Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, China.

Informed consent statement: The patients involved in this report gave their written informed consent for the use and disclosure of their health information.

Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this report.

Correspondence to: Chi Xu, MD, Deputy Director, Department of Hepatic Surgery and Liver Transplantation Center of The Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China. chixuzoe@163.com

Telephone: +86-20-85252177 Fax: +86-20-85252276

Received: August 8, 2016
Peer-review started: August 9, 2016
First decision: September 6, 2016
Revised: September 21, 2016
Accepted: October 19, 2016
Article in press: October 19, 2016
Published online: January 7, 2017
Processing time: 149 Days and 11.4 Hours

Abstract

Biliary stenosis is a common complication after liver transplantation, and has an incidence rate ranging from 4.7% to 12.5% based on our previous study. Three types of biliary stenosis (anastomotic stenosis, non-anastomotic peripheral stenosis and non-anastomotic central hilar stenosis) have been identified. We report the outcome of two patients with anastomotic stricture after liver transplantation who underwent successful cutting balloon treatment. Case 1 was a 40-year-old male transplanted due to subacute fulminant hepatitis C. Case 2 was a 57-year-old male transplanted due to hepatitis B virus-related end-stage cirrhosis associated with hepatocellular carcinoma. Both patients had similar clinical scenarios: refractory anastomotic stenosis after orthotopic liver transplantation and failure of balloon dilation of the common bile duct to alleviate biliary stricture.

Keywords: Liver transplantation; Cutting balloon; Anastomotic; Biliary stenosis; Cholangiography; Balloon dilation

Core tip: Biliary stenosis is the relatively common complication after liver transplantation. Our case report represents one of few documenting evidence of the cutting balloon treatment as a safe and effective procedure in refractory anastomotic stenosis after orthotopic liver transplantation. The cutting balloon treatment could be an alternative therapy to the endoscopic application or the surgical application.