Frequency of Bile Duct Problems
posted by: garylws

How often do post-transplant patients have Biliary Tract or Bile Duct problems?

Biliary obstruction (blocked Bile Duct) is a common problem after Liver transplantation with a reported incidence of 15–25%.

Biliary complications have always been a significant cause of post-transplantation problems. When the old Liver is removed, the Gallbladder is removed with it. The Bile Duct is then attached directly to the Liver.

Because the Bile Duct is so small and has to be attached to the Liver by hand it is not uncommon to develop anastomotic strictures (narrowed openings) where it has been attached to the liver. The Bile does not drain properly from the Liver and can damage it.

It is usually treated successfully by a therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) with balloon dilatation and a stent insertion. The doctor goes down the patients throat, through the stomach and into the Bile Duct where the stent is placed.

An ERCP is an out-patient procedure done under light sedation. The patient can usually go home the same day. In situations of persistent stenosis (narrowing), the standard treatment is reconstructive surgery. The doctor then has to make a large incision in the stomach to make the repair because the Bile Duct is located under the Liver.

Occasionally the doctor must do a Percutaneous Transhepatic Cholangiogram (PTC) to drain the Bile Duct before the ERCP is performed. A tube is placed thru the patients side directly into the Bile Duct for drainage. Infections can often occur anytime that you go into the Biliary Tract. These are usually handled with a round of strong IV anti-biotics. When the infection is brought under control the patient is sent home with anti-biotics in pill form.

Even with reconstructive surgery the problem can re-occur because every time you do surgery you will have a scar. The best thing to do is keep a close watch on your blood test results for elevated ALKP (Alkaline Phosphatase) and GGT (Gamma-glutamyltranspeptidase). These can be signs of Bile Duct problems.

Source: garylws