摘要
Biliary tract diseases are the most common complications following liver transplantation(LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents(FCSEMSs) has not been demonstrated to be superior(except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients.
Biliary tract diseases are the most common complicationsfollowing liver transplantation （LT） and usually includebiliary leaks, strictures, and stone disease. Comparedto deceased donor liver transplantation in adults, livingdonor liver transplantation is plagued by a higher rateof biliary complications. These may be promoted bymultiple risk factors related to recipient, graft, operativefactors and post-operative course. Magnetic resonancecholangiopancreatography is the first-choice examinationwhen a biliary complication is suspected followingLT, in order to diagnose and to plan the optimal therapy;its limitations include a low sensitivity for thedetection of biliary sludge. For treating anastomoticstrictures, balloon dilatation complemented with thetemporary placement of multiple simultaneous plasticstents has become the standard of care and results instricture resolution with no relapse in 〉 90% of cases.Temporary placement of fully covered self-expandingmetal stents （FCSEMSs） has not been demonstrated tobe superior （except in a pilot randomized controlled trialthat used a special design of FCSEMSs）, mostly becauseof the high migration rate of current FCSEMSs models.The endoscopic approach of non-anastomotic stricturesis technically more difficult than that of anastomoticstrictures due to the intrahepatic and/or hilar location ofstrictures, and the results are less satisfactory. For treatingbiliary leaks, biliary sphincterotomy and transpapillarystenting is the standard approach and results inleak resolution in more than 85% of patients. Deepenteroscopy is a rapidly evolving technique that hasallowed successful treatment of patients who were notpreviously amenable to endoscopic therapy. As a result,the percutaneous and surgical approaches are currentlyrequired in a minority of patients.
