Advances in endoscopic management of biliary complications after living donor liver transplantation: Comprehensive review of the literature

Table 1 Results of endoscopic management of biliary complications after adult living donor liver transplantation: A review of the literature

Ref.1	Type of biliary complication	Initial technical success, n (%)2		Final therapeutic success, n (%)3		Recurrence at a mean follow-up months, n (%)4	Endoscopic treatment modality	Number of ERC session per patient5	Duration for final success (mo)5	Factors affecting endoscopic treatment outcomes
Hisatsune et al[41] D-D	Stricture	14/22	(63.6)	2/14	(14.3)	-	IS	1	12	Number of the proximal duct at D-D
Shah et al[35] D-D	Stricture	3/4	(75.0)	3/3	(100)	-	BD and/or PS	1.5	2.3
	Leakage	8/8	(100)	8/8	(100)	-	PS with/without ES	2	1.4
Zoepf et al[26] D-D	Stricture	7/12	(58.3)	7/7	(100)	1/7 (14.3) at 10.0	BD and/or PS	3.5	8
Yazumi et al[12] D-D	Stricture	48/75	(64.0)	28/55	(50.9)	3/28 (10.7) at 1.8	IS with/without BD	-	9	Crane-neck deformity
	Leakage	13/16	(50.0)	8/13	(61.5)	-	ENBD	-	0.6	Non-anastomotic stricture
Tsujino et al[11] D-D	Stricture	12/17	(70.6)	9/12	(75.0)	4/9 (44.4) at 10.1	BD with ENBD/IS	4.1	-
Lee et al[22] D-D	Stricture	12/17	(70.6)	7/14	(50.0)	0/7 (0.0) at 13.1	BD with ENBD/PS	3.9	7.2	Stricture
										Sharp angulation of D-D
	Leakage	11/13	(84.6)	9/11	(81.8)	0/9 (0.0) at 13.1	PS or ENBD	2.2	3	Concomitant bile leakage
Tarantino et al[16] D-D	Stricture	14/20	(70.0)	7/14	(64.3)	-	BD with double PS	3.4	-	Continuous bile leakage despite PS
	Leakage	11/13	(33.3)	3/4	(75.0)	-	ES with PS	2.3	-	Persistence of stricture after 1 yr
	Both	4/6	(66.7)	0/4	(0.0)	-	-	-	-
Kato et al[59] D-D	Stricture	31/41	(75.6)	28/35	(80.0)	7/28 (25.0) at 9.3	BD with PS	4	14.5	Concomitant bile leakage
Kim et al[40] D-D	Stricture	-		38/60	(63.3)	5/38 (13.2) at 7.9	BD with PS	3	-	Shape of distal duct at D-D: pouched
Kobayashi et al[66] D-D	Stricture	-		7/16	(43.8)	-	-	-	-	Delayed diagnosis of stricture
Seo et al[43] D-D	Stricture	15/26	(57.6)	20/29	(68.9)	6/20 (30.0) at 28.0	BD with PS	2.3	6.8	Late onset over 24 wk
										Delayed diagnosis of stricture
										Short duration of biliary stenting
Gómez et al[18] D-D	Stricture	4/10	(40.0)	2/4	(50.0)	-	BD with/without PS	2	-
	Leakage	3/4	(75.0)	3/3	(100)	-	ES with/without PS	3	-
Chang et al[28] D-D	Stricture	63/101	(62.4)	48/90	(53.3)	-	BD with PS	3.2	11	Non-anastomotic stricture
										Hepatic artery stenosis
Lee et al[23] D-D	Stricture	64/137	(46.7)	38/68	(55.9)	-	PS or ENBD	4.8	-	Stricture-to-ERC interval
										Morphology of stricture
										: narrow, separate duct, nonvisualized
										Shape of distal duct at D-D: round tip
Kim et al[61] D-D	Stricture	82/147	(55.8)	52/141	(36.9)	6/52 (11.5) at 21.1	BD with PS	6.3	12.7	Early onset within 1 yr after LDLT
Yaprak et al[58] D-D	Stricture	-		7/13	(53.8)	-	-	-	-	Long length of stricture
	Leakage	-		5/7	(71.4)	-	-	-	-	More than 1 bile duct anastomosis
Chan et al[142] D-D	Stricture	8/8	(100)	6/8	(75.0)	0/6 (0.0) at 3.0	BD with PS	4.7	4.2	Disuse of intraoperative biliary stent
Kurita et al[67] D-D	Stricture	94/118	(79.7)	81/92	(88.0)	8/81 (9.9) at 53.0	BD with IS	1.4	6.3	Use of ES
Hsieh et al[71] D-D	Stricture	32/38	(84.2)	38/38	(100)	8/38 (21.1) at 9.45	BD and maximal PS	4	5.3	Right lobe liver graft
										High-grade stricture
										Sharp angulation of D-D
										Conventional PS vs maximal PS
Chok et al[37] D-D	Stricture	-		41/56	(73.2)	-	BD with/without PS	3	-	Younger recipient age
										Longer operation time
										Shape of distal duct at D-D: pouched
										Initial bile leakage
Na et al[24] D-D	Stricture	53/65	(81.5)	112/129	(86.8)	-	BD and maximal PS	3.2	-	Early period of transplant experience
		-		59/64	(92.2)	-	Rendezvous	-	-
Chang et al[86] D-D	Stricture	20/20	(100)	13/20	(65.0)	-	Rendezvous	2	7.2	Sharp or twisted angle at stricture
Mita et al[77] C-J	Stricture	7/22	(31.8)	-		0/7 (0.0) at 13.3	BD	2	2.5	Tube jejunostomy in long Roux limb
							(deep enteroscopy)
Kamei et al[82] C-J	Stricture	5/9	(55.6)	7/9	(77.8)	4/7 (57.1) at 27.6	BD	2.1	-	Use of a single ERC intervention
							(deep enteroscopy)
Jang et al[97] D-D	Stricture	10/12	(83.3)	10/10	(100)	1/9 (11.1) at 3.3	Magnetic compression anastomosis	-	2.5	Length of stricture
		: magnet approximation		: recanalization						LDLT-to-ERC interval
				9/10	(90.0)				6.1	Architecture of the bile duct
				: stent-free						Strength of the magnet

¹References: Author, Type of biliary reconstruction in study population;

²Initial technical success, n (%): patients who underwent successful ERC intervention/patients receiving a first session of ERC (excluding prior transhepatic rendezvous);

³Final therapeutic success, n (%): patients who achieved cholangiographic resolution without need for further endoscopic, surgical, percutaneous procedures (e.g., stent-free) / patients treated by ERC interventions;

⁴Recurrence, n (%): patients with recurrent biliary problems with cholangiographic evidence and the need for subsequent intervention/patients who resolved;

⁵Values are expressed as mean. BD: Balloon dilatation; C-J: Biliary anastomosis with Roux-en-Y choledochojejunostomy; D-D: Duct-to-duct biliary anastomosis; ENBD: Endoscopic nasobiliary drainage; ERC: Endoscopic retrograde cholangiography; ES: Endoscopic sphincterotomy; IS: Inside-stent placement above the intact sphincter of Oddi; PS: Plastic stent placement.