Novel technique for recanalization of severe hepaticojejunal obstruction using a transseptal needle in a pediatric liver transplant recipient

Kengo Sasaki, Hideki Ota, Shigehito Miyagi, Kazuaki Tokodai, Atsushi Fujio, Toshiaki Kashiwadate, Koji Miyazawa, Muneyuki Matsumura, Yoshikatsu Saitoh, Norifumi Kanai, Hiroyasu Nishimaki, Kei Takase, Michiaki Unno, Takashi Kamei

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Endoscopic and PTB interventions are common nonsurgical interventions for biliary anastomotic strictures that occur after liver transplantation. When these nonsurgical interventions fail, surgical re-anastomosis is considered; however, this is quite invasive and can cause additional injury that may lead to graft loss. We report a case in which conventional nonsurgical interventions failed, but a new method that involve the use of a transseptal needle—a device to create a transseptal left-heart access during cardiac catheter interventions—was successfully used in recanalization of the hepaticojejunal anastomotic obstruction. Case: A 21-year-old man, who had received living-donor liver transplantation for biliary atresia at the age of 23 months presented with recurrent cholangitis and liver dysfunction due to a biliary anastomotic stricture of the hepaticojejunostomy. Therapeutic interventions for biliary stricture, including the PTB approach, double-balloon enteroscopic approach, and rendezvous approach failed. We then performed needle puncture of the anastomotic obstruction using a transseptal needle and succeeded in recanalizing the complete anastomotic obstruction. To perform the procedures safely, we evaluated the organ and needle positions using biplane fluoroscopy and placed a balloon in the afferent jejunal limb as a target for puncture. The 12 Fr catheter via the biliary route was removed 7 months after the procedure, without using a catheter, there was no recurrent stricture or cholangitis for 26 months. Conclusion: Using a transseptal needle to manage hepaticojejunal anastomotic obstruction can reduce the number of patients who need surgical re-anastomosis.

Original languageEnglish
Article numbere14160
JournalPediatric Transplantation
Volume26
Issue number2
DOIs
Publication statusPublished - 2022 Mar

Keywords

  • biliary complications
  • biliary obstruction
  • biliary stricture
  • interventional radiology
  • living-donor liver transplantation
  • transseptal needle

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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