title: Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results.
abstract: OBJECTIVE
  Anastomotic biliary stricture (ABS) is the most common biliary complication after orthotopic liver transplantation (OLT) and can be successfully managed endoscopically. The long-term results of a protocol using placement of multiple plastic stents to treat ABS following OLT were analyzed.
  
  
  METHODS
  All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for OLT-related biliary complications at our Endoscopy Unit between July 1994 and March 2012 were retrospectively identified from the ERCP database. Patients with an ABS treated with an increasing number of plastic stents were included in the study. Follow-up after stent removal was obtained by telephone contact with the patient and/or referring physician and by liver function tests (LFTs) evaluation.
  
  
  RESULTS
  56 patients, treated with an increasing number of plastic stents until resolution of the stricture, were included. Five patients were then excluded (unrelated death during treatment, n = 3; incomplete treatment because of poor compliance, n = 2), and 51/56 patients reached study end points and were included in the analysis. Resolution of ABS was obtained in 50/51 patients; 1 patient required hepaticojejunostomy because of failure to pass the stricture with the guidewire (per protocol resolution, 98 %). Mean duration of endoscopic treatment was 11.5 months, with a median 4 ERCPs per patient. Immediate ERCP-related adverse events occurred in 3/56 patients (5.4 %). After a median follow-up of 5.8 years from stent removal, 3/50 patients (6 %) had recurrence of ABS. These 3 patients were successfully treated again endoscopically and are asymptomatic after a further median follow-up of 5.6 years.
  
  
  CONCLUSIONS
  At long-term follow-up, endoscopic treatment with multiple plastic stents of ABS following OLT appeared to be effective in most patients. Stricture recurrence is rare and can be successfully treated again endoscopically.
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Andrea
authors: A
authors: Tringali
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Federico
authors: F
authors: Barbaro
authors: Surgical Department, Campus Bio Medico University Hospital, Rome, Italy.
authors: Margherita
authors: M
authors: Pizzicannella
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Ivo
authors: I
authors: Boškoski
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Pietro
authors: P
authors: Familiari
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Vincenzo
authors: V
authors: Perri
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Giovanni
authors: G
authors: Gigante
authors: Department of Geriatrics, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Graziano
authors: G
authors: Onder
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Cesare
authors: C
authors: Hassan
authors: Hepatology Unit, National Institute for Infectious Diseases, L. Spallanzani Hospital, Rome, Italy.
authors: Raffaella
authors: R
authors: Lionetti
authors: General Surgery and Transplantation Unit, San Camillo Hospital, Rome, Italy.
authors: Giuseppe Maria
authors: GM
authors: Ettorre
authors: Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy.
authors: Guido
authors: G
authors: Costamagna
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D001652:Bile Ducts / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors