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CardioVascular and Interventional Radiology

Erschienen in:

10.06.2024 | Clinical Investigation

Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study

verfasst von: Ali Husnain, Asad Malik, Juan Caicedo, Satish Nadig, Daniel Borja-Cacho, Justin Boike, Josh Levitsky, Allison Reiland, Bartley Thornburg, Rajesh Keswani, Muhammed Sufyaan Ebrahim Patel, Aziz Aadam, Riad Salem, Andres Duarte, Daniel Ganger, Ahsun Riaz

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 8/2024

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Abstract

Purpose

This study aimed to present the institutional experience and algorithm for performing biliary interventions in liver transplant patients using the modified Hutson loop access (MHLA) and the impact of percutaneous endoscopy via the MHLA on these procedures.

Methods

Over 13 years, 201 MHLA procedures were attempted on 52 patients (45 liver transplants; 24 living and 21 deceased donors) for diagnostic (e.g., cholangiography) and therapeutic (e.g., stent/drain insertion and cholangioplasty) purposes. The most common indications for MHLA were biliary strictures (60%) and bile leaks (23%). Percutaneous endoscopy was used to directly visualize the biliary-enteric anastomosis, diagnose pathology (e.g., ischemic cholangiopathy), and help in biliary hygiene (removing debris/casts/stones/stents) in 138/201 (69%) procedures. Technical success was defined as cannulating the biliary-enteric anastomosis and performing diagnostic/therapeutic procedure via the MHLA.

Results

The technical success rate was 95% (190/201). The failure rate among procedures performed with and without endoscopy was 2% (3/138) versus 13% (8/63) (P = 0.0024), and the need for new transhepatic access (to aid the procedure) was 12% (16/138) versus 30% (19/63) (P = 0.001). Despite endoscopy, failure in 2% of the cases resulted from inflamed/friable anastomosis (1/3) and high-grade stricture (2/3) obstructing retrograde cannulation of biliary-enteric anastomosis. Major adverse events (bowel perforation and injury) occurred in 1% of the procedures, with no procedure-related mortality.

Conclusions

MHLA-based percutaneous biliary intervention is a safe and effective alternative to managing complications after liver transplant. Percutaneous endoscopy via the MHLA improves success rates and may reduce the need for new transhepatic access.

Level of Evidence Level 4

Graphical Abstract

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Titel: Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study
verfasst von: Ali Husnain
Asad Malik
Juan Caicedo
Satish Nadig
Daniel Borja-Cacho
Justin Boike
Josh Levitsky
Allison Reiland
Bartley Thornburg
Rajesh Keswani
Muhammed Sufyaan Ebrahim Patel
Aziz Aadam
Riad Salem
Andres Duarte
Daniel Ganger
Ahsun Riaz
Publikationsdatum: 10.06.2024
Verlag: Springer US
Erschienen in: CardioVascular and Interventional Radiology / Ausgabe 8/2024
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-024-03778-x

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Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study