title: Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video).
abstract: BACKGROUND
  The optimal endoscopic protocol for treating postorthotopic liver transplantation (OLT) anastomotic biliary strictures (ABSs) has not been established.
  
  
  OBJECTIVE
  To review the technique and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) with maximal stenting for post-OLT ABSs at our institution.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary-care center.
  
  
  METHODS
  Eighty-three patients with a diagnosis of ABS.
  
  
  METHODS
  ERCP with balloon dilation and maximal stenting.
  
  
  METHODS
  Stricture resolution, stricture recurrence, and complication rates.
  
  
  RESULTS
  Of 83 patients, 69 completed treatment, of whom 65 (94%) achieved resolution and 4 (6%) required hepaticojejunostomy (HJ). The remaining 14 patients who did not achieve a study endpoint were excluded (9 deaths or redo OLT unrelated to biliary disease, and 5 without follow-up). Comparing the resolution group and the HJ group, there were, respectively, 8.0 and 3.5 total stents (P = .021), 2.5 and 1.3 stents per ERCP (P = .018) (maximum = 9), 4.2 and 2.8 ERCPs (P = .15), and 20 and 22 months from OLT to ABS diagnosis (P = .19). There were 2 cases of ERCP pancreatitis (0.7%) and 2 cases of periprocedural bacteremia of 286 total ERCPs and no episodes of cholangitis caused by stent occlusion. In a median follow-up of 11 months (range 0-39), 2 (3%) patients had ABS recurrence that was successfully re-treated with ERCP. A multivariate Cox model demonstrated that treatment success was directly related to the number of stents used in total and per ERCP.
  
  
  CONCLUSIONS
  Retrospective study, single endoscopist.
  
  
  CONCLUSIONS
  Our maximal stenting protocol for ABSs is effective, safe, rarely associated with ABS recurrence, and conducive to less frequent stent exchange and therefore fewer ERCPs compared with conventional treatment.
authors.affiliation: Dumont-UCLA Liver Transplant Center, Los Angeles, California, USA. jhtabib@ucla.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Tabibian
authors.forename: Emad H
authors.initials: EH
authors.lastname: Asham
authors.forename: Steven
authors.initials: S
authors.lastname: Han
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Myron J
authors.initials: MJ
authors.lastname: Tong
authors.forename: Leonard
authors.initials: L
authors.lastname: Goldstein
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Durazo
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000473:pathology*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003251:Constriction, Pathologic; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014741:Video Recording