Value of percutaneous transhepatic cholangioscopy in the treatment of biliary cast after liver transplantation

Objective: This study aims to investigate the value of percutaneous transhepatic cholangioscopy (PTCS) in the diagnosis and treatment of biliary casts after liver transplantation. Methods: The clinical data of 17 patients who had biliary casts after liver transplantation between April 2008 and January 2013 were analyzed. Result: Of the 17 patients with biliary casts after liver transplantation, 2 patients had biliary casts in the common bile duct, which were treated by endoscopic retrograde cholangiopancreatography (ERCP). Among the remaining 15 patients, 5, 6, and 4 patients had right intrahepatic bile duct, left intrahepatic bile duct, and intrahepatic and extrahepatic widespread biliary casts, respectively. PTCS was conducted 96 times in total, and the biliary casts were successfully cleared in 13 out of 15 patients using the PTCS technique, showing satisfactory treatment outcomes (effective rate, 86.67%). One patient required a long-term drainage tube due to persistent fever when his drainage tube was clipped, even though the biliary casts were cleared. Moreover, one patient underwent a second liver transplantation due to vanishing bile duct syndrome. During the postoperative follow-up of 10-30 months, one patient presented recurring biliary casts in the common bile duct and underwent ERCP in the 15th postoperative month. One patient died due to biloma in 6 months postoperatively. The rest of the patients are in good condition. Conclusion: The PTCS technique is a safe and effective method to treat biliary casts after liver transplantation, and should be the preferred method used clinically.