Endoscopic approach for management of biliary strictures in liver transplant recipients: A systematic review and meta‐analysis

Abstract

The most common biliary complication after liver transplantation is anastomotic stricture (AS) and it can occur isolated or in combination with other complications. Liver graft from a cadaveric donor or a living donor has an influence on the incidence of biliary strictures as well as on the response to endoscopic treatment. Endoscopic treatment using balloon dilation and insertion of biliary stents by endoscopic retrograde cholangiopancreatography (ERCP) is the initial approach to these complications. Aim: The aim of this article is to compare different endoscopic techniques to treat post-liver transplantation biliary strictures. Methods: The search was carried out on MEDLINE, EMBASE, Scielo-LILACS and Cochrane Library databases through June 2015. A total of 1100 articles were retrieved. Ten clinical trials were analyzed, and seven were included in the meta-analysis. Conclusions: The endoscopic treatment of AS was equally effective when compared the use of fully covered self-expandable metal stents (FCSEMS) vs. plastic stents, but the use of FCSEMS was associated with a lower complication risk. The treatment of AS with balloon dilation or balloon dilation associated with plastic stents presented similar results. Deceased donor liver transplantation reduced the risk of biliary stenosis and the endoscopic treatment in these patients was more effective when compared with Living donor liver transplantation.

ACR Appropriateness Criteria® Radiologic Management of Biliary Obstruction

“…The incidence of initial treatment failure was lower with balloon dilatation alone (5%) than with balloon dilatation with plastic stent (8%). However, this meta-analysis also found that the rate of stricture recurrence was higher when initial treatment was with balloon dilatation alone versus balloon dilatation and stent placement (33% versus 27%) [51].…”

Endo‐therapies for biliary duct‐to‐duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey

“…Today endoscopic therapies are the first‐line treatment option for biliary complications after liver transplantation; however, randomized trials comparing radiologic or surgical therapy vs endo‐therapy are not yet available in this area. This point is firmly confirmed by our national survey.…”

Role of Direct Peroral Cholangioscopy in Difficult Biliary Stones: A Case Report

“…Benign biliary strictures are mostly related to liver transplantation or chronic pancreatitis [2]. In fact, anastomotic strictures are one of the most common adverse events after liver transplantation, occurring in up to 34% of cases, being more common in transplants with living liver donors [3]. In the recent years, endoscopic treatment with balloon dilation or biliary stent has become the gold standard, and surgical intervention is reserved for unsuccessful or inaccessible strictures to endoscopic treatment [3].…”

“…In fact, anastomotic strictures are one of the most common adverse events after liver transplantation, occurring in up to 34% of cases, being more common in transplants with living liver donors [3]. In the recent years, endoscopic treatment with balloon dilation or biliary stent has become the gold standard, and surgical intervention is reserved for unsuccessful or inaccessible strictures to endoscopic treatment [3]. Even though the optimal endoscopic strategy for the treatment of these strictures remains to be defined, in a recent metaanalysis, Aparício et al [3] concluded that the endoscopic treatment of anastomotic strictures with fully covered self-expandable metal stents was equally effective as the treatment with plastic stents, but the former was associated with a lower complication risk.…”

“…In the recent years, endoscopic treatment with balloon dilation or biliary stent has become the gold standard, and surgical intervention is reserved for unsuccessful or inaccessible strictures to endoscopic treatment [3]. Even though the optimal endoscopic strategy for the treatment of these strictures remains to be defined, in a recent metaanalysis, Aparício et al [3] concluded that the endoscopic treatment of anastomotic strictures with fully covered self-expandable metal stents was equally effective as the treatment with plastic stents, but the former was associated with a lower complication risk. Also, the use of sin- gle-balloon dilation or balloon dilation combined with plastic stents presented similar outcomes [3].…”