title: Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy.
abstract: BACKGROUND
  The optimal endoscopic treatment for anastomotic biliary strictures after deceased donor liver transplantation is undefined. Endoscopic therapy with conventional methods of biliary dilation and stent placement has been successful but often requires prolonged therapy.
  
  
  OBJECTIVE
  To determine the outcomes of an aggressive endoscopic approach that uses endoscopic dilation followed by maximal stent placement.
  
  
  METHODS
  Tertiary-care academic medical center.
  
  
  METHODS
  Of 176 patients who underwent deceased donor liver transplantation between June 1999 and July 2004, 25 were diagnosed with anastomotic biliary strictures.
  
  
  METHODS
  Patients were treated endoscopically with a combined technique of balloon dilation and maximal stent placement.
  
  
  METHODS
  Treatment outcomes, including bile-duct patency, a need for surgical intervention, morbidity, and mortality, were evaluated retrospectively.
  
  
  RESULTS
  Endoscopic dilation followed by maximal stent placement was performed until resolution of strictures in 22 of 25 patients (88% immediate success on intent-to-treat analysis). Persistent resolution of strictures was achieved in 18 of these 22 patients. Re-treatment was successful in 2 of 4 patients with recurrent strictures. Overall, 20 of 22 patients who completed endoscopic therapy (91%) avoided surgical intervention. Median duration of endoscopic treatment was 4.6 months. Patients with early onset strictures required a significantly shorter duration of endoscopic therapy (3 vs 9 months; P<.01). Multiple stent placement was not technically difficult, and no major complications were encountered.
  
  
  CONCLUSIONS
  Aggressive endoscopic therapy with combined biliary dilation and maximal stent placement allows resolution of anastomotic biliary strictures after deceased donor liver transplantation in a relatively short period, with sustained success and minimal complications.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
authors.forename: Shabana F
authors.initials: SF
authors.lastname: Pasha
authors.forename: M Edwyn
authors.initials: ME
authors.lastname: Harrison
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
authors.forename: Cuong C
authors.initials: CC
authors.lastname: Nguyen
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Vargas
authors.forename: Vijayan
authors.initials: V
authors.lastname: Balan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Byrne
authors.forename: David D
authors.initials: DD
authors.lastname: Douglas
authors.forename: David C
authors.initials: DC
authors.lastname: Mulligan
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D002102:Cadaver; D002404:Catheterization; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome