Technical challenges of percutaneous transhepatic biliary drainage in adult biliary atresia patients post Kasai portoenterostomy

Abstract

Biliary atresia (BA) is a severe hepatobiliary condition requiring Kasai portoenterostomy (KP) during infancy to facilitate biliary flow. However, post-KP, patients frequently develop complications such as recurrent cholangitis, biliary stricture, and cystic intrahepatic dilatation. These complications often progress to biliary cirrhosis and end-stage liver disease, necessitating liver transplantation.

In this context, we explore the application of Percutaneous Transhepatic Biliary Drainage (PTBD) for treating biliary complications in post-KP BA patients. PTBD in these cases is technically challenging due to the presence of biliary strictures and intrahepatic bile duct dilatation, and its effectiveness has been a subject of debate.

This paper presents two technically challenge cases where we treated adult BA patients who developed late-onset biliary strictures following successful KP. Both of the required first direct puncture of a cystic region of biliary dilatation, followed by successful puncture (one patient was punctured on CT-guidance) and wire cannulation and successful PTBD insertion. Following the procedure, both patients achieved short-term and long-term clinical improvement. The significant findings from these cases include: resolution of acute cholangitis, normalization of liver enzymes, no evidence of biliary cirrhosis in subsequent ultrasound, and removal of both patients from the liver transplantation list.