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Endoscopic Management of Biliary Complications after Liver Transplant

Orthotropic liver transplant (OLT) is the definitive treatment for patients with end stage liver disease of all etiologies. Biliary complications are common after OLT and living donor liver transplant (LDLT). Approximately, 15% of patients undergoing deceased donor liver transplant develop strictures and this number is even higher in LDLT recipients (28–32%).1
 2 Common biliary complications include anastomotic and non-anastomotic strictures, bile leaks, biliary casts, and stones.3 Endoscopic therapy has become the mainstay of management of these biliary conditions. Endoscopic therapy involves sphincterotomy, dilation, and stent deployment to maintain patency of the bile duct and provide adequate drainage. This article will review current literature regarding endoscopic management of biliary complications after liver transplant and discuss recent endoscopic advances that can reduce the need for reoperation.