title: Endoscopic treatment of post-liver transplantation anastomotic biliary stricture: systematic review and meta-analysis.
abstract: BACKGROUND
  Biliary strictures after liver transplantation are recognized as its Achilles' heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results.
  
  
  OBJECTIVE
  The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation.
  
  
  METHODS
  A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013.
  
  
  RESULTS
  No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates.
  
  
  CONCLUSIONS
  Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.
authors.affiliation: Departamento de Gastroenterologia, Divisão de Transplante Hepático e Gastrointestinal, Laboratório de Investigação Médica, LIM-37 FMUSP, São Paulo, SP, Brasil.
authors.forename: Lucas Souto
authors.initials: LS
authors.lastname: Nacif
authors.affiliation: Projeto Diretrizes, Associação Médica Brasileira, São Paulo, SP, Brasil.
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo
authors.affiliation: Projeto Diretrizes, Associação Médica Brasileira, São Paulo, SP, Brasil.
authors.forename: Luca
authors.initials: L
authors.lastname: Bernardo
authors.affiliation: Departamento de Gastroenterologia, Divisão de Transplante Hepático e Gastrointestinal, Laboratório de Investigação Médica, LIM-37 FMUSP, São Paulo, SP, Brasil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
authors.affiliation: Departamento de Gastroenterologia, Divisão de Transplante Hepático e Gastrointestinal, Laboratório de Investigação Médica, LIM-37 FMUSP, São Paulo, SP, Brasil.
authors.forename: Lucas
authors.initials: L
authors.lastname: Torres
authors.affiliation: Departamento de Gastroenterologia, Divisão de Transplante Hepático e Gastrointestinal, Laboratório de Investigação Médica, LIM-37 FMUSP, São Paulo, SP, Brasil.
authors.forename: Eleazar
authors.initials: E
authors.lastname: Chaib
authors.affiliation: Departamento de Gastroenterologia, Divisão de Transplante Hepático e Gastrointestinal, Laboratório de Investigação Médica, LIM-37 FMUSP, São Paulo, SP, Brasil.
authors.forename: Luiz Carneiro
authors.initials: LC
authors.lastname: D'Albuquerque
authors.affiliation: Departamento de Gastroenterologia, Divisão de Transplante Hepático e Gastrointestinal, Laboratório de Investigação Médica, LIM-37 FMUSP, São Paulo, SP, Brasil.
authors.forename: Fauze
authors.initials: F
authors.lastname: Maluf-Filho
mesh_terms: D001660:Biliary Tract Diseases / Q000209:etiology* / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*