Endoscopic treatment of biliary tract disease prior to orthotopic liver transplantation |
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Authors: | Roshan Shrestha MD David M S Grunkemeier MD |
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Institution: | (1) Piedmont Liver Transplant Program, Piedmont Hospital, 1968 Peachtree Road N.W., Fifth Floor, 77 Building, 30309 Atlanta, GA, USA |
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Abstract: | Opinion statement Endoscopic therapy for biliary tract disease in patients with end-stage liver disease (ESLD) before liver transplantation
is safe and effective. Reported results in patients with choledocholithiasis, primary sclerosing cholangitis (PSC), and symptomatic
gallbladder diseases are encouraging. Prompt recognition and appropriate treatment of symptomatic gallbladder and bile duct
disease are important in reducing morbidity and mortality in these high-risk patients while they await liver transplantation.
Confirmation of tissue diagnosis of cholangiocarcinoma in patients with sclerosing cholangitis is still difficult. Better
screening tools and diagnostic methods are necessary for early detection. Because liver transplantation is the only definitive
therapy for patients with advanced cirrhosis, maintenance of their candidacy with either endoscopic or radiologic therapeutic
interventions is warranted until transplantation. Endoscopic therapy is the preferred method when feasible. If necessary,
percutaneous transhepatic biliary drainage (PTBD) is a viable alternative because both avoid the attendant risks of surgery
in a high-risk population with advanced liver disease. |
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