title: Long-term outcomes of endoscopic management for biliary strictures after living donor liver transplantation with duct-to-duct reconstruction.
abstract: Biliary strictures after living donor liver transplantation (LDLT) with duct-to-duct (D-D) reconstruction are associated with postoperative morbidity and mortality. The aims of this study were to evaluate the long-term outcomes of endoscopic deployment of plastic stents, and to investigate factors associated with the stent deployment failure. Between April 2001 and May 2007, 96 patients received LDLT with D-D reconstruction at Okayama University Hospital. Among them, 41 patients (43%) had anastomotic biliary strictures, and all were referred first for endoscopic retrograde cholangiography (ERC). When deployment was unsuccessful, a percutaneous transhepatic procedure was employed. Successful stent deployment was achieved in 35 out of total 41 patients (85%) by both procedures. Among the 35 patients, 28 had their stents removed as a result of strictures resolution. Eight patients underwent ERC and repeated stent deployment as a result of recurrence of the strictures. Finally, 21 out of 41 (51%) patients with biliary stricture were completely treated by endoscopic therapy during the observation period (median 873 days: range 77-2060). By multivariate analysis, biliary leakage was associated with stent deployment failure. Endoscopic deployment of plastic stents is a first-line therapy for patients with biliary stricture after LDLT.
authors.affiliation: Department of Gastroenterology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Hironari
authors.initials: H
authors.lastname: Kato
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Ryo
authors.initials: R
authors.lastname: Harada
authors.forename: Masakuni
authors.initials: M
authors.lastname: Fujii
authors.forename: Ken
authors.initials: K
authors.lastname: Hirao
authors.forename: Naoko
authors.initials: N
authors.lastname: Kurihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Mizuno
authors.forename: Etsuji
authors.initials: E
authors.lastname: Ishida
authors.forename: Tsuneyoshi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Fukatsu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Takahito
authors.initials: T
authors.lastname: Yagi
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002779:Cholestasis / Q000601:surgery / Q000628:therapy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome