Background

Biliary complications in the post-liver transplant population are common and are a source of significant morbidity, which are preferably managed, if technically feasible, by endoscopic retrograde cholangiography (ERC), depending on anatomy. Cholangioscopy is an advanced biliary imaging adjunct to ERC which allows for direct visualization of the biliary lumen and epithelium, and allows for targeted sampling. Single operator cholangioscopy (SOC) is the currently commercially available system with high clinical success rates in visualization of the biliary tree. However, its use in the post-liver transplant population has not been well established in the literature. The aim of this study is to describe a single center experience using SOC (Spyglass Legacy, Boston Scientific, Malborough, MA) for evaluation and management of post-transplant biliary complications.

Methods

This is a single-center, retrospective case series examining the use of spyglass cholangioscopy in liver transplant recipients at a high volume transplant hepatology center between January 2008 and November 2014. Data regarding indications, exam findings, procedural characteristics, and outcomes were collected.

Results

Nineteen liver transplant recipients (13 men, mean age 59.6 years [range 41-70 years]) underwent SOC for abnormal biliary labs or imaging during this time period. Indications for SOC included selective cannulation of high grade anastomotic strictures (n=11), abnormal liver tests (n=10), abnormal imaging (n=7), stone therapy (n=1), hemobilia (n=1), and bile leak (n =1). Most patients evaluated for stricture were successfully treated after selective cannulation by SOC. Unexpected findings of biliary casts were seen in 9 patients (47%). Of the nine patients with biliary casts, only 3 patients (33%) required surgery, while the rest (66%) were managed endoscopically. Of the patients with bile duct biopsies, 50% of the biopsies showed acute or chronic inflammation. Four patients required surgical correction for their biliary complications (75% for casts and 25% for stricture).

Conclusions

Cholangioscopy is a promising addition to the endoscopic armamentarium for post-liver transplant patients with biliary complications, as it can allow for early endoscopic identification and management of cast syndrome in patients that may have otherwise required surgery. Advances in SOC such as digital imaging and changes in delivery systems may increase the use and role of this technology in managing liver transplant recipients.

CITATION INFORMATION: Agbim U, Verna E, Brown, Jr R, Sethi A. Cholangioscopy in Liver Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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