THE BENEFITS OF ADDING DIGITAL CHOLANGIOSCOPY IN THE EVALUATION AND TREATMENT OF POST-TRANSPLANT BILIARY COMPLICATIONS

Aims We aim to explore diagnostic, therapeutic benefits and safety profile of Digital Single-Operator Cholangioscopy (DSOC)in patients with biliary complications after liver transplantation (LT) in cases,failed to be managed with ERCP.

Methods We performed a single centre prospective study on the role of DSOC in patients with post-LT biliary complications, enrolled in the period 2016 - 2019. Over this period 21 patients with biliary obstruction afterorthotopic LT underwent ERCP, in 9 of cases without success. All 9 were further evaluated using DSOC. Technical success of DSOC consisted in visualization of biliary complication (1) and endoscopic treatment (2). The peri-procedural prophylaxis includes 3-5 days systemic wide spectrum antibiotics.

Results Average patient age was 50.2 years (77.7% male). Six patients (6/9) were diagnosed with anastomotic stricture, two (2/9) with non-anastomotic stricture and one was proven to have bile cast syndrome. We achieved accurate diagnosis in 8/9 (88.8%) patients, and 7/9 (77.7%) were successfully managed during cholangioscopy.In 6 cases the strictures ware successfully visualized and cannulation under direct visual control was achieved. One patient, thought to have long anastomotic CBD stricture on imaging modalities including ERCP, further evaluated with cholangioscopy was found to have bile cast syndrome. The latter was successfully washed out during the procedure, and patient demonstrates stable resolution of cholestasis in follow up of one year.In 2/9 cases we didn’t achieve the therapeutic aim - one patient with large size of anastomotic dehiscence and one with multiple non-anastomotic strictures. Adverse events: One patient (1/9) developed mild pancreatitis, completely resolved in three days.

Conclusions Our study demonstrates DSOC benefits translated into an increase of endoscopic treatment success rate. In our regard, cholangioscopy could spare the need of more aggressive percutaneous interventions and surgical revisions in selected patients. No serious adverse events related to the procedure were observed.