Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video).
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.
Tabibian
James H
JH
Dumont-UCLA Liver Transplant Center, Los Angeles, California, USA. jhtabib@ucla.edu
Asham
Emad H
EH
Han
Steven
S
Saab
Sammy
S
Tong
Myron J
MJ
Goldstein
Leonard
L
Busuttil
Ronald W
RW
Durazo
Francisco A
FA
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