Tratamiento percutáneo de las estenosis biliares tras el trasplante hepático infantil: seguridad y eficacia del protocolo de dilatación biliar «en una sesión»

IF 1.5 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

RADIOLOGIA Pub Date : 2026-03-01 Epub Date: 2025-03-18 DOI:10.1016/j.rx.2025.01.008

M.E. Perez Montilla , M.S. Lombardo Galera , P.B. García Jurado , S. Barranco Acosta , J.J. Espejo Herrero

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Abstract

Objective

This work aims to evaluate the safety and efficacy of percutaneous balloon dilatation (BD) carried out in a single session to treat biliary strictures/obstructions after paediatric liver transplantation (LT).

Material and methods

This retrospective single-centre study enrolled 20 paediatric patients (< 18 years) with biliary strictures/obstructions following a LT carried out between 2013 and 2023. The treatment consisted of a percutaneous transhepatic cholangiography and BD during a single session (no external/internal catheter was left). Data was collected regarding demographics, clinical information, procedural details and any complications. Clinical and radiological follow-ups assessed clinical efficacy and recurrence. All cases of recurrence underwent percutaneous treatment. Recurrence risk factors were evaluated. The primary and secondary patency rates were determined at 6, 12, 24, and 62 months.

Results

Seventeen patients (mean age, 5 years) with anastomotic (13/76.5%) and non-anastomotic (4/23.5%) biliary stricture were treated. Two patients had complications (11.8%). Mean follow-up time was 7.3 years. Clinical success was 82.3% (14/17). In 5 children (29.4%) the single-session BD resolved the biliary stricture. The stricture recurred in 12 patients (70.6%). The recurrence rate was 69.2% for anastomotic strictures and 75% for non-anastomotic strictures (p = 0.670). Recurrences were treated percutaneously (18 second treatments): BD (13) and biliary stent (5). Surgery was avoided in 94.1% of patients. Primary patency rates at 6, 12, 24, 62 months were 76.5, 51, 38.2 and 25.5%, respectively. Secondary patency rates at 6, 12, 24, 62 months were 100, 100, 88.9 and 88.9%, respectively.

Conclusion

Single-session percutaneous BD is an effective treatment for biliary stricture/obstruction after paediatric LT, often preventing the need for surgery or retransplantation.

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儿童肝移植后胆管狭窄经皮治疗：“单次”胆管扩张方案的安全性和有效性

目的评价单次经皮球囊扩张（BD）治疗小儿肝移植（LT）术后胆道狭窄/梗阻的安全性和有效性。材料和方法本回顾性单中心研究纳入了2013年至2023年间行肝移植后胆道狭窄/梗阻的20例儿童患者（18岁）。治疗包括单次经皮经肝胆管造影和BD（不留下外部/内部导管）。收集了有关人口统计学、临床信息、手术细节和任何并发症的数据。临床和放射学随访评估临床疗效和复发率。所有复发病例均经皮治疗。评估复发危险因素。分别在6个月、12个月、24个月和62个月测定原发性和继发性通畅率。结果手术治疗吻合口狭窄（13/76.5%）和非吻合口狭窄（4/23.5%）17例，平均年龄5岁。2例出现并发症（11.8%）。平均随访时间7.3年。临床成功率为82.3%（14/17）。5例患儿（29.4%）单疗程BD解决了胆道狭窄。狭窄复发12例（70.6%）。吻合口狭窄复发率为69.2%，非吻合口狭窄复发率为75% （p = 0.670）。复发患者经皮治疗（18秒）：BD（13例）和胆道支架（5例）。94.1%的患者避免了手术。6、12、24、62个月的原发性通畅率分别为76.5%、51%、38.2%和25.5%。6个月、12个月、24个月、62个月的二次通畅率分别为100,100,88.9和88.9%。结论单次经皮胆道移植术是治疗小儿肝移植后胆道狭窄/梗阻的有效方法，可避免手术或再移植。

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来源期刊

RADIOLOGIA RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

1.60

自引率

7.70%

发文量

105

审稿时长

52 days

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