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Single-operator cholangioscopy for biliary complications in liver transplant recipients

AIM: To evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT). METHODS: Twenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complicat...

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Autores principales: Hüsing-Kabar, Anna, Heinzow, Hauke Sebastian, Schmidt, Hartmut Hans-Jürgen, Stenger, Carina, Gerth, Hans Ulrich, Pohlen, Michele, Thölking, Gerold, Wilms, Christian, Kabar, Iyad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473125/
https://www.ncbi.nlm.nih.gov/pubmed/28652659
http://dx.doi.org/10.3748/wjg.v23.i22.4064
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author Hüsing-Kabar, Anna
Heinzow, Hauke Sebastian
Schmidt, Hartmut Hans-Jürgen
Stenger, Carina
Gerth, Hans Ulrich
Pohlen, Michele
Thölking, Gerold
Wilms, Christian
Kabar, Iyad
author_facet Hüsing-Kabar, Anna
Heinzow, Hauke Sebastian
Schmidt, Hartmut Hans-Jürgen
Stenger, Carina
Gerth, Hans Ulrich
Pohlen, Michele
Thölking, Gerold
Wilms, Christian
Kabar, Iyad
author_sort Hüsing-Kabar, Anna
collection PubMed
description AIM: To evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT). METHODS: Twenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between April and December 2016 at the university hospital of Muenster were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation. All patients received peri-interventional antibiotic prophylaxis and bile was collected during the intervention for microbial analysis and for antibiotic susceptibility testing. RESULTS: Thirty-three biliary complications were found in a total of 22 patients, whereas four patients showed normal bile ducts. Anastomotic strictures were evident in 14 (53.8%) patients, non-anastomotic strictures in seven (26.9%), biliary cast in three (11.5%), and stones in six (23.1%). A benefit of cholangioscopy was seen in 12 (46.2%) patients. In four of them, cholangioscopy was crucial for selective guidewire placement prior to planned intervention. In six patients, biliary cast and/or stones failed to be diagnosed by ERCP and were only detectable through cholangioscopy. In one case, a bile duct ulcer due to fungal infection was diagnosed by cholangioscopy. In another case, signs of bile duct inflammation caused by acute cholangitis were evident. One patient developed post-interventional cholangitis. No further procedure-related complications occurred. Thirty-seven isolates were found in bile. Sixteen of these were gram-positive (43.2%), 12 (32.4%) were gram-negative bacteria, and Candida species accounted for 24.3% of all isolated microorganisms. Interestingly, only 48.6% of specimens were sensitive to prophylactic antibiotics. CONCLUSION: Single-operator cholangioscopy can provide important diagnostic information, helping endoscopists to plan and perform interventional procedures in LT-related biliary complications.
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spelling pubmed-54731252017-06-26 Single-operator cholangioscopy for biliary complications in liver transplant recipients Hüsing-Kabar, Anna Heinzow, Hauke Sebastian Schmidt, Hartmut Hans-Jürgen Stenger, Carina Gerth, Hans Ulrich Pohlen, Michele Thölking, Gerold Wilms, Christian Kabar, Iyad World J Gastroenterol Observational Study AIM: To evaluate cholangioscopy in addition to endoscopic retrograde cholangiopancreatography (ERCP) for management of biliary complications after liver transplantation (LT). METHODS: Twenty-six LT recipients with duct-to-duct biliary reconstruction who underwent ERCP for suspected biliary complications between April and December 2016 at the university hospital of Muenster were consecutively enrolled in this observational study. After evaluating bile ducts using fluoroscopy, cholangioscopy using a modern digital single-operator cholangioscopy system (SpyGlass DS™) was performed during the same procedure with patients under conscious sedation. All patients received peri-interventional antibiotic prophylaxis and bile was collected during the intervention for microbial analysis and for antibiotic susceptibility testing. RESULTS: Thirty-three biliary complications were found in a total of 22 patients, whereas four patients showed normal bile ducts. Anastomotic strictures were evident in 14 (53.8%) patients, non-anastomotic strictures in seven (26.9%), biliary cast in three (11.5%), and stones in six (23.1%). A benefit of cholangioscopy was seen in 12 (46.2%) patients. In four of them, cholangioscopy was crucial for selective guidewire placement prior to planned intervention. In six patients, biliary cast and/or stones failed to be diagnosed by ERCP and were only detectable through cholangioscopy. In one case, a bile duct ulcer due to fungal infection was diagnosed by cholangioscopy. In another case, signs of bile duct inflammation caused by acute cholangitis were evident. One patient developed post-interventional cholangitis. No further procedure-related complications occurred. Thirty-seven isolates were found in bile. Sixteen of these were gram-positive (43.2%), 12 (32.4%) were gram-negative bacteria, and Candida species accounted for 24.3% of all isolated microorganisms. Interestingly, only 48.6% of specimens were sensitive to prophylactic antibiotics. CONCLUSION: Single-operator cholangioscopy can provide important diagnostic information, helping endoscopists to plan and perform interventional procedures in LT-related biliary complications. Baishideng Publishing Group Inc 2017-06-14 2017-06-14 /pmc/articles/PMC5473125/ /pubmed/28652659 http://dx.doi.org/10.3748/wjg.v23.i22.4064 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Observational Study
Hüsing-Kabar, Anna
Heinzow, Hauke Sebastian
Schmidt, Hartmut Hans-Jürgen
Stenger, Carina
Gerth, Hans Ulrich
Pohlen, Michele
Thölking, Gerold
Wilms, Christian
Kabar, Iyad
Single-operator cholangioscopy for biliary complications in liver transplant recipients
title Single-operator cholangioscopy for biliary complications in liver transplant recipients
title_full Single-operator cholangioscopy for biliary complications in liver transplant recipients
title_fullStr Single-operator cholangioscopy for biliary complications in liver transplant recipients
title_full_unstemmed Single-operator cholangioscopy for biliary complications in liver transplant recipients
title_short Single-operator cholangioscopy for biliary complications in liver transplant recipients
title_sort single-operator cholangioscopy for biliary complications in liver transplant recipients
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473125/
https://www.ncbi.nlm.nih.gov/pubmed/28652659
http://dx.doi.org/10.3748/wjg.v23.i22.4064
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