Endoskopisches Management von Gallengangskomplikationen nach Leberchirurgie

Martha M. Kirstein; Torsten Voigtländer

doi:10.1055/a-1857-5775

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Table of Contents

Zentralbl Chir 2022; 147(04): 398-406
DOI: 10.1055/a-1857-5775

Übersicht

Endoskopisches Management von Gallengangskomplikationen nach Leberchirurgie

Endoscopic Management of Biliary Complications Following Hepatobiliary Surgery

Martha M. Kirstein

¹First Department of Medicine, UKSH Lübeck, Lübeck, Deutschland

,

Torsten Voigtländer

²Gastroenterologie, Deutsches Rotes Kreuz Krankenhaus Clementinenhaus Hannover, Hannover, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Biliäre Komplikationen stellen häufige Komplikationen nach Leberchirurgie dar und tragen wesentlich zur postoperativen Morbidität und Mortalität bei. Den größten Anteil dieser machen Gallengangsleckagen und -strikturen aus, wobei die Leckagen nach Cholezystektomie und Leberresektion dominieren und die Strikturen ein wesentliches Problem nach Lebertransplantationen darstellen. Patienten nach orthotoper Lebertransplantation stellen besonders vulnerable Patienten dar, deren biliäre Komplikationen von denen nach Cholezystektomie und Leberresektion differieren und niederschwellig sowie mit größter Vorsicht behandelt werden müssen. Mit der endoskopischen retrograden Cholangiografie steht ein exzellentes Verfahren zur Behandlung dieser Komplikationen zur Verfügung. Die therapeutischen Möglichkeiten beinhalten die endoskopische Sphinkterotomie, die Anlage von Prothesen und Dilatationen. Mittels dieser Verfahren können Erfolgsraten in bis zu 90% der Fälle erreicht werden. Bei Hepatikojejunostomien bestehen alternative Interventionsmöglichkeiten wie die ballon- oder motorunterstützte antegrade Enteroskopie, die perkutan-transhepatische Cholangiodrainage oder mit zunehmendem Einsatz die endosonografisch gestützten Verfahren.

Abstract

Biliary complications are frequent after hepatic surgery and may greatly influence postoperative morbidity and mortality. Most of these are leaks or strictures to the bile duct, most frequently leaks after cholecystectomy and liver resection. Strictures are an important problem after liver transplantation. Patients after orthotopic liver transplantation are particularly vulnerable, as they are different from biliary complications after liver resection and must be treated very sensitively and carefully. Endoscopic retrograde cholangiography is an excellent procedure for treating these complications. The therapeutic properties include endoscopic sphincterotomy, insertion of prostheses and dilatations. These procedures can give success rates of up to 90% of cases. For hepatico-jejunostomies, there are alternative possibilities of intervention, such as balloon- or motor-supported antegrade enteroscopy, percutaneous transhepatic cholangio drainage or the increasing use of endosonographically supported procedures.

Schlüsselwörter

Leberresektion - Leberversagen - interventionelle Endoskopie

Keywords

liver failure - liver resection - interventional endoscopy

Full Text

References

Literatur
1 Balderramo D, Navasa M, Cardenas A. Current management of biliary complications after liver transplantation: emphasis on endoscopic therapy. Gastroenterol Hepatol 2011; 34: 107-115
2 Brown jr. RS, Russo MW, Lai M. et al. A survey of liver transplantation from living adult donors in the United States. N Engl J Med 2003; 348: 818-882
3 Kochhar G, Parungao JM, Hanouneh IA. et al. Biliary complications following liver transplantation. World J Gastroenterol 2013; 19: 2841-2846
4 Lo CM, Fan ST, Liu CL. et al. Biliary Complications After Hepatic Resection Risk Factors, Management, and Outcome. Arch Surg 1998; 133: 156-161
5 Bismuth H, Chiche L, Castaing D. Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: experience with 68 liver resections. World J Surg 1995; 19: 35-41
6 Doci R, Gennari L, Bignami P. et al. Morbidity and mortality after hepatic resection of metastases from colorectal cancer. Br J Surg 1995; 82: 377-381
7 Miyagawa S, Makuuchi M, Kawasaki S. et al. Criteria for safe hepatic resection. Am J Surg 1995; 169: 589-594
8 Tsao JI, Loftus JP, Nagorney DM. et al. Trends in morbidity and mortality of hepatic resection for malignancy: a matched comparative analysis. Ann Surg 1994; 220: 199-205
9 Vlaemynck K, Lahousse L, Vanlander A. et al. Endoscopic management of biliary leaks: a systematic review with meta-analysis. Endoscopy 2019; 51: 1074-1081
10 Canena J, Horta D, Coimbra J. et al. Outcomes of endoscopic management of primary and refractory postcholecystectomy biliary leaks in a multicentre review of 178 patients. BMC Gastroenterol 2015; 15: 105
11 Dumonceau JM, Kapral C, Aabakken L. et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 127-149
12 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-683
13 Gutt C, Jenssen C, Barreiros AP. et al. Aktualisierte S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) zur Prävention, Diagnostik und Behandlung von Gallensteinen AWMF-Register-Nr. 021/008. Z Gastroenterol 2018; 56: 912-966
14 Farooqui W, Penninga L, Burgdorf SK. et al. Biliary Leakage Following Pancreatoduodenectomy: Experience from a High-Volume Center. J Pancreat Cancer 2021; 7: 80-85
15 Abbas A, Sethi S, Brady P. et al. Endoscopic management of postcholecystectomy biliary leak: when and how? A nationwide study. Gastrointest Endosc 2019; 90: 233-241.e1
16 Baron TH, Poterucha JJ. Insertion and removal of covered expandable metal stents for closure of complex biliary leaks. Clin Gastroenterol Hepatol 2006; 4: 381-386
17 Aksoz K, Unsal B, Yoruk G. et al. Endoscopic sphincterotomy alone in the management of low-grade biliary leaks due to cholecystectomy. Dig Endosc 2009; 21: 158-161
18 Llach J, Bordas JM, Elizalde JI. et al. Sphincterotomy in the treatment of biliary leakage. Hepato-Gastroenterology 2002; 49: 1496-1498
19 Sandha GS, Bourke MJ, Haber GB. et al. Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc 2004; 60: 567-574
20 Katsinelos P, Kountouras J, Paroutoglou G. et al. A comparative study of 10-Fr vs. 7-Fr straight plastic stents in the treatment of postcholecystectomy bile leak. Surg Endosc 2008; 22: 101-110
21 Mavrogiannis C, Liatsos C, Papanikolaou IS. et al. Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of postlaparoscopic cholecystectomy biliary leaks: a prospective randomized study. Eur J Gastroenterol Hepatol 2006; 18: 405-409
22 Dolay K, Soylu A, Aygun E. The role of ERCP in the management of bile leakage: endoscopic sphincterotomy versus biliary stenting. J Laparoendosc Adv Surg Tech A 2010; 20: 455-459
23 Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol 2002; 97: 2763-2767
24 Dumonceau JM, Tringali A, Papanikolaou IS. et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2018; 50: 910-930
25 Dumonceau JM, Tringali A, Blero D. et al. Biliary stenting: Indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44: 277-292
26 Canena J, Liberato M, Meireles L. et al. A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos). Gastrointest Endosc 2015; 82: 70-78
27 Nuñez jr. D, Becerra JL, Martin LC. Subhepatic collections complicating laparoscopic cholecystectomy: percutaneous management. Abdom Imaging 1994; 19: 248-250
28 Sammak BM, Yousef BA, Gali MH. et al. Case report: radiological and endoscopic management of bile leak following laparoscopic cholecystectomy. J Gastroenterol Hepatol 1997; 12: 34-38
29 Oliva VL, Nicolet V, Soulez G. et al. Bilomas developing after laparoscopic biliary surgery: percutaneous management with embolization of biliary leaks. J Vasc Interv Radiol 1997; 8: 469-473
30 Tonozuka R, Itoi T, Tsuchiya T. et al. EUS-guided drainage of hepatic abscess and infected biloma using short and long metal stents (with videos). Gastrointest Endosc 2015; 81: 1463-1469
31 Ogura T, Masuda D, Saori O. et al. Clinical outcome of endoscopic ultrasound-guided liver abscess drainage using self-expandable covered metallic stent (with video). Dig Dis Sci 2016; 61: 303-308
32 Lillemoe KD. Benign post-operative bile duct strictures. Baillieres Clin Gastroenterol 1997; 11: 749-779
33 Huszár O, Kokas B, Mátrai P. et al. Meta-analysis of the long term success rate of different interventions in benign biliary strictures. PLoS One 2017; 12: e0169618
34 Artifon EL, Coelho F, Frazao M. et al. A prospective randomized study comparing partially covered metal stent versus plastic multistent in the endoscopic management of patients with postoperative benign bile duct strictures: a follow-up above 5 years. Rev Gastroenterol Peru 2012; 32: 26-31
35 Jin S, Fu Q, Wuyun G. et al. Management of post-hepatectomy complications. World J Gastroenterol 2013; 19: 7983-7991
36 Fan ST, Lai EC, Lo CM. et al. Hepatectomy with an ultrasonic dissector for hepatocellular carcinoma. Br J Surg 1996; 83: 117-120
37 Shimada M, Matsumata T, Akazawa K. et al. Estimation of risk of major complications after hepatic resection. Am J Surg 1994; 167: 399-403
38 Lee CC, Chau GY, Lui WY. et al. Risk factors associated with bile leakage after hepatic resection for hepatocellular carcinoma. Hepatogastroenterology 2005; 52: 1168-1171
39 Sadamori H, Yagi T, Matsuda H. et al. Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases. J Hepatobiliary Pancreat Sci 2010; 17: 709-718
40 Bhattacharjya S, Puleston J, Davidson BR. et al. Outcome of early endoscopic biliary drainage in the management of bile leaks after hepatic resection. Gastrointest Endos 2003; 57: 526-530
41 Yamashita Y, Hamatsu T, Rikimaru T. et al. Bile leakage after hepatic resection. Ann Surg 2001; 233: 45-50
42 Farhat S, Bourrier A, Gaudric M. et al. Endoscopic treatment of biliary fistulas after complex liver resection. Ann Surg 2011; 253: 88-93
43 Parlak E, Disibeyaz S, Odemiş B. et al. Endoscopic treatment of biliary fistulas developing after liver resections. Surg Laparosc Endosc Percutan Tech 2013; 23: 453-458
44 Trotter JF, Wachs M, Everson GT. et al. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med 2002; 346: 1074-1082
45 Verdonk RC, Buis CI, Porte RJ. et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl 2006; 12: 726-735
46 Beltran MM, Marugan RB, Oton E. et al. Accuracy of magnetic resonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation. Transplant Proc 2005; 37: 3924-3925
47 Linhares MM, Gonzalez AM, Goldman SM. et al. Magnetic resonance cholangiography in the diagnosis of biliary complications after orthotopic liver transplantation. Transplant Proc 2004; 36: 947-948
48 Novellas S, Caramella T, Fournol M. et al. MR cholangiopancreatography features of the biliary tree after liver transplantation. Am J Roentgenol 2008; 191: 221-227
49 Rerknimitr R, Sherman S, Fogel EL. et al. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy. Gastrointest Endosc 2002; 55: 224-231
50 Pfau PR, Kochman ML, Lewis JD. et al. Endoscopic management of postoperative biliary complications in orthotopic liver transplantation. Gastrointest Endosc 2000; 52: 55-63
51 Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int 2003; 23: 156-162
52 Thethy S, Thomson B, Pleass H. et al. Management of biliary tract complications after orthotopic liver transplantation. Clin Transplant 2004; 18: 647-653
53 Thuluvath PJ, Pfau PR, Kimmey MB. et al. Biliary complications after liver transplantation: the role of endoscopy. Endoscopy 2005; 37: 857-863
54 Graziadei IW, Schwaighofer H, Koch R. et al. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl 2006; 12: 718-725
55 Testa G, Malago M, Broelseh CE. Complications of biliary tract in liver transplantation. World J Surg 2001; 25: 1296-1299
56 Pasha SF, Harrison ME, Das A. et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc 2007; 66: 44-51
57 Holt AP, Thorburn D, Mirza D. et al. A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation 2007; 84: 857-863
58 Tabibian JH, Asham EH, Han S. et al. Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video). Gastrointest Endosc 2010; 71: 505-512
59 Morelli J, Mulcahy HE, Willner IR. et al. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointest Endosc 2003; 58: 374-379
60 Kulaksiz H, Weiss KH, Gotthardt D. et al. Is stenting necessary after balloon dilation of post-transplantation biliary strictures? Results of a prospective comparative study. Endoscopy 2008; 40: 746-751
61 Tal AO, Finkelmeier F, Filmann N. et al. Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: a prospective, randomized, multicenter trial. Gastrointest Endosc 2017; 86: 1038-1045
62 Kaffes A, Griffin S, Vaughan R. et al. A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation. Therap Adv Gastroenterol 2014; 7: 64-71
63 Martins FP, de Paulo GA, Contini MLC. et al. Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial. Gastrointest Endosc 2018; 87: 131.e1-131.e13
64 Lee DW, Jo HH, Abdullah J. et al. Endoscopic management of anastomotic strictures after liver transplantation. Clin Endosc 2016; 49: 457-461
65 Traina M, Tarantino I, Barresi L. et al. Efficacy and safety of fully overed self-expandable metallic stents in biliary complications after liver transplantation: a preliminary study. Liver Transpl 2009; 15: 1493-1498
66 Spier BJ, Pfau PR, Lorenze KR. et al. Risk factors and outcomes in post-liver transplantation bile duct stones and casts: a case–control study. Liver Transpl 2008; 14: 1461-1465
67 Buis CI, Verdonk RC, Van der Jagt EJ. et al. Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation. Liver Transpl 2007; 13: 708-718
68 Verdonk RC, Buis CI, van der Jagt EJ. et al. Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression. Liver Transpl 2007; 13: 725-732
69 Zoepf T, Maldonado de Dechêne EJ, Dechêne A. et al. Optimized endoscopic treatment of ischemic-type biliary lesions after liver transplantation. Gastrointest Endosc 2012; 76: 556-563
70 Antolovic D, Koch M, Galindo L. et al. Hepaticojejunostomy--analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg 2007; 11: 555-561
71 Kadaba RS, Bowers KA, Khorsandi S. et al. Complications of biliary-enteric anastomoses. Ann R Coll Surg Engl 2017; 99: 210-215
72 Zafar SN, Khan MR, Raza R. et al. Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis. BMC Surg 2011; 25: 19
73 Burkhart RA, Relles D, Pineda DM. et al. Defining treatment and outcomes of hepaticojejunostomy failure following pancreaticoduodenectomy. J Gastrointest Surg 2013; 17: 451-460
74 House MG, Cameron JL, Schulick RD. et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243: 571-576
75 Sato T, Kogure H, Nakai Y. et al. Double-balloon endoscopy-assisted treatment of hepaticojejunostomy anastomotic strictures and predictive factors for treatment success. Surg Endosc 2020; 34: 1612-1620
76 Shah RJ, Smolkin M, Yen R. et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc 2013; 77: 593-600
77 Tanisaka Y, Ryozawa S, Mizuide M. et al. Status of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: Systematic review and meta-analysis on biliary interventions. Dig Endosc 2021; 33: 1034-1044
78 Beyna T, Arvanitakis M, Schneider M. et al. Motorised spiral enteroscopy: first prospective clinical feasibility study. Gut 2021; 70: 261-267
79 Beyna T, Schneider M, Höllerich J. et al. Motorized spiral enteroscopy-assisted ERCP after Roux-en-Y reconstructive surgery and bilioenteric anastomosis: first clinical case. VideoGIE 2020; 5: 311-313
80 Mizukawa S, Tsutsumi K, Kato H. et al. Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple’s procedure: a retrospective study. BMC Gastroenterol 2018; 18: 14
81 Gwon DI, Ko GY, Ko HK. et al. Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: mid-term outcomes in 68 patients. Dig Dis Sci 2013; 58: 3270-3279
82 Giménez ME, Palermo M, Houghton E. et al. Biodegradable biliary Stent: a new approach for the management of hepaticojejunostomy strictures following bile duct injury. Arq Bras Cir Dig 2016; 29: 112-116
83 Battistel M, Senzolo M, Ferrarese A. et al. Biodegradable Biliary Stents for Percutaneous Treatment of Post-liver Transplantation Refractory Benign Biliary Anastomotic Strictures. Cardiovasc Intervent Radiol 2020; 43: 749-755
84 House MG, Cameron JL, Schulick RD. et al. Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 2006; 243: 571-576
85 Schumacher B, Othman T, Jansen M. et al. Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy 2001; 33: 409-415
86 Sportes A, Camus M, Greget M. et al. Endoscopic ultrasound-guided hepaticogastrostomy versus percutaneous transhepatic drainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography: a retrospective expertise-based study from two centers. Therap Adv Gastroenterol 2017; 10: 483-493
87 Wang K, Zhu J, Xing L. et al. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 2016; 83: 1218-1227
88 Coté GA, Slivka A, Tarnasky P. et al. Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution: A Randomized Clinical Trial. JAMA 2016; 315: 1250-1257
89 Pascher A, Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation. J Hepatobiliary Pancreat Surg 2006; 13: 487-496