Therapeutic challenges in the multidisciplinary approach of liver transplant-associated biliary tract complications in Roux-en-Y gastric bypass patients.

INTRODUCTION

This case series addresses the available non-surgical approaches for the management of biliary tract complications in liver transplant (LT) patients with a history of Roux-en-Y gastric bypass (RYGB).

METHODS

Descriptive single center case series of endoscopic and radiological treatments of biliary tract complications in LT recipients with a history of RYGB.

RESULTS

Balloon enteroscopy-assisted-ERCP (BE-ERCP), endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE), percutaneous transhepatic biliary drainage (PTBD), or a combination of these procedures are used according to the clinical indication or the surgical biliary reconstruction (duct-to-duct anastomosis vs hepaticojejunostomy) in conjunction with RYGB. Case 1 was treated with PTBD, followed by BE-ERCP; case 2 with BE-ERCP, followed by EDGE; case 3 with PTBD, followed by EDGE; and case 4 with BE-ERCP.

CONCLUSION

Both BE-ERCP, EDGE and PTBD in different combinations are reliable non-surgical therapeutic approaches for treating LT-associated biliary tract complications in RYGB patients.