Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review

BACKGROUND/AIMS: Bile leak is one of the most common complications of liver transplantation. The treatment options for bile leaks include conservative management, surgical re-intervention, percutaneous drainage and endoscopic drainage. We aimed to perform a systematic review to identify the efficacy of endoscopic treatment in the resolution of post-transplant bile leaks. METHODS: Two independent reviewers performed systematic literature search in PubMed, ISI Web of Science, grey literature and relevant references in May 2017. Human studies in English with documented post-liver transplant bile leaks were included. RESULTS: Thirty-four studies were included in the final analysis. The pooled efficacy of biliary stents for the resolution of post-transplant bile leaks was 82.43% compared with 87.15% efficacy of nasobiliary tubes. The efficacy of biliary stents was lower for anastomotic leaks (69.23%) compared to T-tube (90.9%) or cut-surface/ cystic duct stump related leaks (92.8%). Similarly, the efficacy of nasobiliary tube was also lower for anastomotic leaks (58.33%) compared to T-tube or cut-surface related leaks (100%). CONCLUSIONS: In this systematic review, the overall efficacy was 82.43% in biliary stent group, and 87.15% in nasobiliary tube group. Both biliary stent and nasobiliary tube were more effective in managing non-anastomotic leaks compared to anastomotic leaks.

Clinical application of innovative intake duct driven from nasobiliary tube via nose / 中国内镜杂志

Objective To investigate whether an innovative intake duct driven from nasobiliary tube via nose improved the success rate of oronasal conversion and shorten the operation time.Methods 118 patients with routine nose bile duct drainage under ERCP examination were randomly divided into magnetic group and thread group. Patients in magnetic group were using a self-made nasal biliary drainage tube derived via nasal catheter traction and nasal catheter, one end of the magnet will be equipped with high performance through mouth to mouth pharynx, smooth delivery nose bile duct. While patients in thread group adopts godet from pharynx posterior wall drawing pulled stomach tube or catheter again, then ifx the nose bile duct.Results The success rate was signiifcantly higher in magnetic group than thread group, with less stimulation of pharynx, and less complications.Conclusion Self-made intake duct derived magnetic catheter was simple and less stimulation, avoid oral mucosa damage, reduced the suffering of patients, shortened operation time and improved the operation efifciency with high success rate.