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Gastrointest Endosc. 2010 Mar;71(3):505-12. doi: 10.1016/j.gie.2009.10.023.

Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video).

Author information

1
Dumont-UCLA Liver Transplant Center, Los Angeles, California, USA. jhtabib@ucla.edu

Erratum in

  • Gastrointest Endosc. 2010 Sep;72(3):674.

Abstract

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.

DESIGN:

Retrospective study.

SETTING:

Tertiary-care center.

PATIENTS:

Eighty-three patients with a diagnosis of ABS.

INTERVENTIONS:

ERCP with balloon dilation and maximal stenting.

MAIN OUTCOME MEASUREMENTS:

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.

LIMITATIONS:

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.

PMID:
20189508
DOI:
10.1016/j.gie.2009.10.023
[Indexed for MEDLINE]

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