An Emerging Problem: our experience for Multidisciplinary Treatment of Liver Transplant-Associated Biliary Complications in Patients with Roux-En-Y Gastric Bypass

There is an increasing number of patients with a history of both liver transplantation (LT) and Roux-en-Y gastric bypass (RYGB). Biliary tract complications are the most prevalent LT-associated complication, with endoscopic retrograde cholangiopancreatography (ERCP) as the preferred therapeutic approach. However, surgically altered anatomy after RYGB renders ERCP technically challenging. We performed an overview of endoscopic treatment modalities of biliary tract complications in LT recipients with a history of RYGB. Different techniques are discussed and illustrated with clinical cases.

Balloon enteroscopy-assisted-ERCP (BE-ERCP), endoscopic ultrasound (EUS)-directed trans gastric endoscopic retrograde cholangiopancreatography (EDGE), percutaneous trans hepatic biliary drainage (PTBD), or a combination of these procedures can be used according to the clinical indication or the surgical reconstruction of the bile duct. Case 1 was treated with PTBD, followed by BE-ERCP; case 2 was treated with BE-ERCP, followed by EDGE; case 3 was treated with PTBD, followed by EDGE; and case 4 was treated with BE-ERCP [1] [2] [3] [4] [5] [6] [7].

The management of LT-associated biliary tract complications in patients with RYGB anatomy poses a significant challenge and prompts a multidisciplinary discussion for deciding the optimal strategy. Next to PTBD, both BE-ERCP and EDGE have emerged as promising endoscopic therapeutic methods for this indication, owing to their established safety and efficacy in various other clinical contexts. More studies focusing on this specific population are warranted to comprehensively assess the efficacy and safety profiles of these procedures.

Publication History

Article published online:
27 March 2025

• References

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