title: Risk factors for early repeat ERCP in liver transplantation patients with anastomotic biliary stricture.
abstract: Anastomotic biliary strictures (ABS) are a significant clinical problem associated with decreased survival post-liver transplantation (LT). Contributing to the morbidity of ABS is the need for early (i.e. emergent or unplanned) repeat endoscopic retrograde cholangiopancreatographies (ER-ERCPs). Our aim was to determine clinical, operative, and endoscopic predictors of ER-ERCP in patients with ABS.
  
  
  
  Medical records of 559 patients who underwent LT at our institution from 2000-2012 were retrospectively reviewed for pertinent data. The primary endpoint was need for ER-ERCP. Seventeen potential predictors of ER-ERCP were assessed in bivariate analyses, and those with p < 0.20 were included in multivariate regression models.
  
  
  
  Fifty-four LT patients developed ABS and underwent a total of 200 ERCPs, of which 40 met criteria for ER-ERCP. Predictors of ER-ERCP in bivariate analyses included balloon dilation within 3 months post-LT and donation after cardiac death (both p < 0.05). Balloon dilation within 3 months post-LT was also associated with shorter ER-ERCP-free survival (p = 0.02). Moreover, a significantly higher proportion (67%) of patients who underwent balloon dilation within 3 months post-LT subsequent experienced ≥ 1 ER-ERCP (p = 0.03), and those who experienced ≥ 1 ER-ERCP had lower stricture resolution rates at the end of endoscopic therapy compared to those who did not (79 vs. 97%, p = 0.02). In multivariate analyses, balloon dilation within 3 months post-LT was the strongest predictor of ER-ERCP (OR 3.8, 95% CI 1.7-8.6, p = 0.001).
  
  
  
  Balloon dilation of ABS within 3 months post-LT is associated with an increased risk of ER-ERCP, which itself is associated with lower ABS resolution rates. Prospective studies are needed to confirm these findings and their implications for endoscopic management and follow-up of post-LT ABS.
authors: Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors: James H
authors: JH
authors: Tabibian
authors: Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: Mohit
authors: M
authors: Girotra
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Hsin-Chieh
authors: HC
authors: Yeh
authors: Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: Vikesh K
authors: VK
authors: Singh
authors: Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: Patrick I
authors: PI
authors: Okolo
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Andrew M
authors: AM
authors: Cameron
authors: Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: Ahmet
authors: A
authors: Gurakar
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001652:Bile Ducts / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D012086:Reoperation; D012307:Risk Factors; D015607:Stents; D014481:United States