Biliary Manometric Perfusion Test in Evaluating the Efficacy of Balloon Cholangioplasty for Non-Anastomotic Biliary Strictures after Orthotopic Liver Transplantation

The aim of the study was to determine the role of biliary manometric perfusion test in evaluating the efficacy of percutaneous balloon cholangioplasty (balloon dilation) for biliary strictures in patients after orthotopic liver transplantation (OLT).

Materials and Methods. During the period of 1998–2016, 168 patients underwent 179 OLTs in the Russian Research Center for Radiology and Surgical Technologies named after Academician A.M. Granov (Saint Petersburg). Non-anastomotic biliary stricturesrequiring interventional radiological procedures occurred in 15 patients (8.4% of the total number of OLTs) within 3 to 62 months after surgery.

The study involved 6 patients who underwent 43 stricture dilations (3 to 14) with balloon catheters of 4 to 8 mm diameter after percutaneous transhepatic cholangiodrainage. External-internal cholangiodrainage of 8 F diameter was left in place after bilioplasty. Treatment procedures were repeated under intravenous anesthesia once in 2–3 months.

Biliary manometric perfusion test was performed after positive X-ray control of biliary patency within 6 to 17 months from the beginning of bilioplasty. The drains were removed from the guidewire, introducers of 9–10 F diameter were placed in the bile duct above the stricture. 30% solution of Ultravist-350 was infused into the ducts in the following modes: 4 ml/min during 5 min; 8 ml/min — 5 min; 15 ml/min — 3 min; 20 ml/min — 2 min.Fluid pressure was measured within the ducts before and after the infusion. The result of balloon dilation was considered successful if the pressure before and after the infusion did not exceed 200 mm WG. In these cases, external-internal drain was removed.

Results. Based on the manometry data, 9 drains were successfully removed in all 6 patients during the period of 8 to 22 months from the time of cholangiodrainage. The patients were followed up for 4 to 40 months without radiographic and biochemical signs of biliary hypertension and cholestasis.

Conclusion. Biliary manometric perfusion test may serve as an effective minimally invasive method to control the efficacy of balloon cholangioplasty for biliary strictures in patients after orthotopic liver transplantation.

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Polikarpov A.A., Tarazov P.G., Polekhin A.S., Moiseenko A.V., Karakhanov K.I., Borovik V.V., Granov D.A. Biliary Manometric Perfusion Test in Evaluating the Efficacy of Balloon Cholangioplasty for Non-Anastomotic Biliary Strictures after Orthotopic Liver Transplantation. Sovremennye tehnologii v medicine 2017; 9(4): 60, https://doi.org/10.17691/stm2017.9.4.07