title: Endoscopic treatment for biliary stricture after orthotopic liver transplantation: success, recurrence and their influencing factors.
abstract: OBJECTIVE
  To investigate the success and recurrence rates and factors influencing the effect of endoscopic therapy for patients with biliary stricture after orthotopic liver transplantation (OLT).
  
  
  METHODS
  Data of 56 patients who underwent endoscopic therapy for biliary stricture after OLT from 2006 to 2009 were reviewed in this study. Their clinical data, laboratory parameters and endoscopic features were recorded.
  
  
  RESULTS
  Biliary stricture was treated successfully in 47 patients (83.9%). Compared with those with treatment failure, there was a longer duration from OLT to initial presentations (P = 0.02) in the successful group, fewer endoscopic retrograde cholangiopancreatography (ERCP) treatments (P < 0.01) and fewer stents inserted per patient (P < 0.01). Multivariate analysis showed that the number of ERCP treatments per patient was negatively related with treatment success. Of the 47 patients successfully treated, stricture recurred in 13 (27.7%) during follow-up. Compared with those without recurrence, the recurrence group had a shorter initial presentation time after OLT, higher serum alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase levels, higher numbers of ERCP treatments and stents used and a longer duration of treatment (P < 0.01 for all). Multivariate analysis showed that the treatment duration was a risk factor for recurrence (OR 2.33, 95% CI 1.34-4.05, P < 0.01).
  
  
  CONCLUSIONS
  Endoscopic treatment is a safe and effective modality for biliary stricture after OLT. The number of ERCP treatments per patient is negatively related with treatment success and long treatment duration was a risk factor for stricture recurrence.
authors.affiliation: Department of Gastroenterology and Hepatology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Xiao Bo
authors.initials: XB
authors.lastname: Cai
authors.forename: Feng
authors.initials: F
authors.lastname: Zhu
authors.forename: Jian Jun
authors.initials: JJ
authors.lastname: Wen
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.forename: Ru Ling
authors.initials: RL
authors.lastname: Zhang
authors.forename: Hui
authors.initials: H
authors.lastname: Zhou
authors.forename: Xin Jian
authors.initials: XJ
authors.lastname: Wan
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000453:epidemiology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome