Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2015; 7(30): 2927-2932
Published online Dec 28, 2015. doi: 10.4254/wjh.v7.i30.2927
Role of endoscopy in the conservative management of biliary complications after deceased donor liver transplantation
Andrea Lisotti, Pietro Fusaroli, Giancarlo Caletti
Andrea Lisotti, Unità Operativa di Gastroenterologia, Ospedale Nuovo di Imola, 40026 Imola, Italy
Andrea Lisotti, Pietro Fusaroli, Giancarlo Caletti, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
Andrea Lisotti, Pietro Fusaroli, Giancarlo Caletti, Gastroenterology Unit, Hospital of Imola, 40026 Imola, Italy
Author contributions: Lisotti A and Fusaroli P wrote the paper; Caletti G revised the final draft of the manuscript for important intellectual content.
Conflict-of-interest statement: All Authors declare no conflict of interest for this study and for the preparation of this manuscript.
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/
Correspondence to: Andrea Lisotti, PhD, Unità Operativa di Gastroenterologia, Ospedale Nuovo di Imola, via Montericco 9, 40026 Imola, Italy. lisotti.andrea@gmail.com
Telephone: +39-0542-662407 Fax: +39-0542-662409
Received: June 9, 2015
Peer-review started: June 19, 2015
First decision: September 18, 2015
Revised: October 21, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: December 28, 2015
Abstract

The clinical outcome of patients receiving liver transplantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these conditions lead to markedly reduction in morbidity and mortality. Therapeutic gold standard is represented by conservative approaches, both endoscopic and percutaneous, based on the type of biliary reconstruction, the local availability of the procedures and specific expertise. In patients with previous transplantation, the difficult biliary access and the possible presence of concomitant complications (mainly strictures) further restrict the efficacy of the endoscopic and percutaneous treatments; on the other hand, surgery should generally be avoided because of the even increased morbidity and mortality due to technical and clinical issues. Here we review the most common biliary complications occurring after liver transplantation and discuss available treatment options including future perspectives such as endoscopic ultrasound-guided biliary access in patients with Roux-en-Y choledocho-jejunostomy or extracorporeal shock wave lithotripsy for difficult stones.

Keywords: Endoscopic ultrasonography, Endoscopic ultrasound, Percutaneous trans-hepatic drainage, Endoscopic retrograde cholangiopancreatography, Biliary drainage

Core tip: The clinical outcome of patients receiving liver transplantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these conditions allow to markedly reduction in morbidity and mortality. With the continuous increase of endoscopic knowledge and expertise, the interventional management of these conditions is constantly evolving toward a conservative approach. In this manuscript are summarized current evidences regarding conservative approaches to biliary complication, with an overview on future management and research areas.