ERCP or a percutaneous route -- the right fix for post-transplant bile duct trouble depends on the problem.
Eyad Gadour, Bogdan Miutescu, Mohammed Saad AlQahtani, et al.
This systematic review of 31 studies compares endoscopic and percutaneous approaches for managing biliary complications after liver transplantation. Endoscopic retrograde cholangiopancreatography worked best for bile leaks and accessible strictures, while percutaneous techniques were more effective for complex or non-anastomotic strictures and as a rescue option, each carrying its own complication profile. The authors recommend tailoring the choice to the type of complication and institutional expertise, with combined approaches reserved for the hardest cases.
- The question: After a liver transplant, which route is better for fixing a troubled bile duct?
- The study: A systematic review compared endoscopic and percutaneous approaches across 31 studies.
- The finding: Endoscopic retrograde cholangiopancreatography worked best for bile leaks and accessible strictures, while percutaneous techniques were more effective for complex or non-anastomotic strictures.
- The nuance: Percutaneous access also served as a rescue option, and each approach carried its own complication profile.
Takeaway: match the route to the type of complication and local expertise, reserving combined approaches for the hardest cases.
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