title: Long-term outcome of endoscopic and/or percutaneous transhepatic therapy in patients with biliary stricture after orthotopic liver transplantation.
abstract: BACKGROUND
  Biliary strictures are a serious complication after liver transplantation. Endoscopic and percutaneous transhepatic procedures have gained an increasing potential for the management of this problem.
  
  
  OBJECTIVE
  Long-term follow-up of endoscopic and/or percutaneous transhepatic therapy of biliary strictures after liver transplantation was evaluated.
  
  
  METHODS
  Between January 1996 and December 2007, 47 patients with biliary stricture after liver transplantation were identified by analysing the endoscopic database, hospital charts and cholangiograms. Long-term follow-up was evaluated using cholangiograms, transabdominal ultrasound, laboratory parameters and physical examination.
  
  
  RESULTS
  The type of biliary stricture after liver transplantation was subdivided into anastomotic stricture (n = 29), non-anastomotic stricture (n = 14) and bilioenterostomy stricture (n = 4). Of the patients, 38/47 were treated by endoscopic procedures (ERCP), and 9/47 patients were treated by percutaneous transhepatic procedures (PTBD). In 2 of 47 patients combined approaches (rendezvous technique) were performed. Overall, 23/29 patients in the anastomotic group, 12/14 patients in the non-anastomotic group, and 3/4 patients in the bilioenterostomy group had successfully completed endoscopic and/or percutaneous transhepatic therapy. Biliary drainage could be respectively terminated after median 9 (1-83), 11 (1-89) and 10 (4-14) months.
  
  
  CONCLUSIONS
  Endoscopic as well as percutaneous transhepatic approaches in combination or as monotherapy are effective in the management of anastomotic and non-anastomotic strictures after liver transplantation.
authors.affiliation: Department of Gastroenterology and Hepatology, Technical University of Munich, Munich, Germany. andreas.weber@lrz.tum.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Weber
authors.forename: Christian
authors.initials: C
authors.lastname: Prinz
authors.forename: Carlos
authors.initials: C
authors.lastname: Gerngross
authors.forename: Leopold
authors.initials: L
authors.lastname: Ludwig
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
authors.forename: Bruno
authors.initials: B
authors.lastname: Neu
authors.forename: Matthias P
authors.initials: MP
authors.lastname: Ebert
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
authors.forename: Hans
authors.initials: H
authors.lastname: Weidenbach
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.forename: Ewert
authors.initials: E
authors.lastname: Schulte-Frohlinde
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000601:surgery; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic