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

World J Gastroenterol. 2016 Jul 21;22(27):6173-91. doi: 10.3748/wjg.v22.i27.6173.


Apart from noticeable improvements in surgical techniques and immunosuppressive agents, biliary complications remain the major causes of morbidity and mortality after living donor liver transplantation (LDLT). Bile leakage and stricture are the predominant complications. The reported incidence of biliary complications is 15%-40%, and these are known to occur more frequently in living donors than in deceased donors. Despite the absence of a confirmed therapeutic algorithm, many approaches have been used for treatment, including surgical, endoscopic, and percutaneous transhepatic techniques. In recent years, nonsurgical approaches have largely replaced reoperation. Among these, the endoscopic approach is currently the preferred initial treatment for patients who undergo duct-to-duct biliary reconstruction. Previously, endoscopic management was achieved most optimally through balloon dilatation and single or multiple stents placement. Recently, there have been significant developments in endoscopic devices, such as novel biliary stents, as well as advances in endoscopic technologies, including deep enteroscopy, the rendezvous technique, magnetic compression anastomosis, and direct cholangioscopy. These developments have resulted in almost all patients being managed by the endoscopic approach. Multiple recent publications suggest superior long-term results, with overall success rates ranging from 58% to 75%. This article summarizes the advances in endoscopic management of patients with biliary complications after LDLT.

Keywords: Biliary complication; Endoscopic management; Endoscopic retrograde cholangiography; Liver transplantation; Living donor.

Publication types

  • Review

MeSH terms

  • Anastomosis, Surgical
  • Anastomotic Leak / surgery*
  • Biliary Tract Diseases / surgery*
  • Biliary Tract Surgical Procedures / methods*
  • Catheterization
  • Cholangiopancreatography, Endoscopic Retrograde / methods*
  • Constriction, Pathologic
  • Dilatation
  • Endoscopy, Digestive System / methods
  • Humans
  • Liver Transplantation*
  • Living Donors
  • Postoperative Complications / surgery*
  • Sphincter of Oddi Dysfunction / surgery*
  • Stents