Percutaneous Access of the Modified Hutson Loop for Retrograde Cholangiography,Endoscopy, and Biliary Interventions |
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| Institution: | 1. Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois;2. Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois;3. Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, Illinois;4. Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona;1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;1. Department of Radiology, Ludwig-Maximilians University, Munich, Germany;2. Pathological Institute, Ludwig-Maximilians University, Munich, Germany;3. Evidensia Veterinary Clinic for Small Animals GmbH Norderstedt, Norderstedt, Germany;4. Research and Development Laboratory, microParticles GmbH, Berlin, Germany;5. Department of Radiology, Charité, Humboldt University Medical School, Berlin, Germany;1. Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China;2. Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China;1. Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA;3. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA;2. Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, Connecticut, USA;4. Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA |
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| Abstract: | PurposeThe purpose of this study was to present the institutional experience of performing endoscopy, cholangiography, and biliary interventions through the modified Hutson loop by interventional radiology.Materials and MethodsA total of 61 of 64 modified Hutson loop access procedures were successful. This single-center retrospective study included 61 successful procedures of biliary interventions using existing modified Hutson loops (surgically affixed subcutaneous jejunal limb adjacent to biliary anastomosis or anastomoses) for diagnostic or therapeutic purposes in 21 patients. Seventeen of 21 patients (81%) had undergone liver transplantation. Indications included biliary strictures (n = 18) and biliary leaks (n = 3). The clinical success and complications were evaluated.ResultsThere were 3 of 26 modified Hutson loop retrograde biliary intervention failures (12%) before introduction of endoscopy and no failures (0 of 38 0%]) subsequently (P = .06). Endoscopy or cholangioscopy was performed in 19 procedures by interventional radiologists. Retrograde biliary interventions included diagnostic cholangiography (n = 26), cholangioplasty (n = 25), stent placement (n = 29), stent retrieval (n = 25), and biliary drainage catheter placement (n = 5). No procedure-related mortality occurred. There was 1 major complication (duodenal perforation) (1.6%) and 12 minor complications (19%). In the 9 patients undergoing therapeutic interventions for biliary strictures, there was a significant decrease in median alkaline phosphatase (288.5 to 174.5 U/L; P = .03). There was a trend toward decrease in median bilirubin levels (1.7 to 1 mg/dL; P = .06) at 1 month post-intervention.ConclusionsThe modified Hutson loop provided interventional radiologists a safe and effective alternative access to manage biliary complications in patients with biliary-enteric anastomoses. Introduction of the endoscope in interventional radiology has improved the success rate of these procedures. |
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| Keywords: | LT"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"liver transplantation PTC"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"percutaneous transhepatic cholangiography |
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