Endoscopic treatment results for bile duct stones after liver transplantation with duct-to-duct reconstruction

Abstract

In patients with biliary duct-to-duct reconstruction after liver transplantation, anastomotic stricture (AS) is often present, making endoscopic retrograde cholangiography (ERC) procedure difficult to treat bile duct stones (BDSs). We retrospectively evaluated the ERC results for BDSs in 18 patients with duct-to-duct reconstruction. Thirteen patients (72%) had AS, and the rate of long-time ERC (one hour or more) was significantly higher in patients with intrahepatic stones with AS than in those with common bile duct stones (39% vs. 0%, p=0.008). Moreover, the combination rate of electrohydraulic lithotripsy (EHL) was high at 50% (p=0.025), ERC was particularly difficult in cases of intrahepatic stones with AS. Furthermore, the stone recurrence rate is high in patients with AS (33%), suggesting that AS is a risk for stone formation. In ERC after liver transplantation, it is important not only to remove the stones but also to treat the stricture.