Long-term outcomes of endoscopic management for biliary strictures after living donor liver transplantation with duct-to-duct reconstruction.
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.
Kato
Hironari
H
Department of Gastroenterology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Kawamoto
Hirofumi
H
Tsutsumi
Koichiro
K
Harada
Ryo
R
Fujii
Masakuni
M
Hirao
Ken
K
Kurihara
Naoko
N
Mizuno
Osamu
O
Ishida
Etsuji
E
Ogawa
Tsuneyoshi
T
Fukatsu
Hirotoshi
H
Yamamoto
Kazuhide
K
Yagi
Takahito
T
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