Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results

Tringali, Andrea; Barbaro, Federico; Pizzicannella, Margherita; Boškoski, Ivo; Familiari, Pietro; Perri, Vincenzo; Gigante, G.; Onder, Graziano; Hassan, Cesare; Lionetti, Raffaella; Ettorre, Giuseppe Maria; Costamagna, Guido

doi:10.1055/s-0042-100277

Cited by 47 publications

(49 citation statements)

References 18 publications

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“…This study raises the question that monitoring patients over a longer period may detect more recurrences, regardless of the type of stenting. Published studies regarding stenting in post-LT strictures have the drawback of a short-term follow-up [14] . Our study includes patients with successfully treated strictures with a long-term follow-up, up to 114 months.…”

Section: Discussionmentioning

confidence: 99%

“…Our study includes patients with successfully treated strictures with a long-term follow-up, up to 114 months. Recently, a retrospective study with 56 patients analysed the long-term results of endoscopic management of post-LT AS with plastic stents, reporting a high rate of success and low recurrence, with a median follow-up of 69 months (5.8 years) [14] .…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Endoscopic Retrograde Cholangiopancreatography in the Treatment of Biliary Complications following Liver Transplant: 10 Years of a Single-Centre Experience

Alves¹,

Gomes²,

Furtado

et al. 2017

GE Port J Gastroenterol

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0.001). The number of ERCP performed per patient was: 3.8 ± 2.4 in AS, 3.8 ± 2.1 in NAS, 1.9 ± 1 in BDS, and 1.9 ± 0.5 in BL ( p = 0.003). The duration of the treatment was: 18 ± 19 months in AS, 21 ± 17 months in NAS, 10 ± 10 months in BDS, and 4 ± 3 months in BL ( p = 0.064). Overall, biliary complications were successfully managed by ERCP in 46% of cases, either as an isolated procedure (43%) or rendez-vous ERCP (3%). Per complication, ERCP was effective in 39% of AS, in 12% of NAS, in 91% of BDS, and in 86% of BL. Globally, the mean follow-up of the successful cases was 43 ± 31 months. Percutaneous transhepatic cholangiography and/or surgery were performed in 48% of patients in whom ERCP was unsuccessful. The odds ratio for effective endoscopic treatment was 0.2 for NAS (0.057-0.815), 12.4 for BDS (1.535-100.9), and 6.9 for BL (0.798-58.95). No statistical significance was found for AS ( p = 0.247). Conclusions: ERCP allowed the treatment of biliary complication in about half of patients, avoiding a more invasive procedure. Endoscopic treatment was more effective for BDS and BL. AbstractBackground and Aims: Biliary tract complications following liver transplant remain an important source of morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) has become a common therapeutic option before other invasive procedures. The aim of this study was to evaluate ERCP efficacy in managing this type of complications. Methods: Retrospective study of all patients who underwent therapeutic ERCP due to post-liver transplant biliary complications between September 2005 and September 2015, at a deceased donor liver transplantation centre. Results: Therapeutic ERCP was performed in 120 patients (64% men; mean age 46 ± 14 years). Biliary complications were anastomotic strictures (AS) in 70%, non-anastomotic strictures (NAS) in 14%, bile leaks (BL) in 5.8%, and bile duct stones (BDS) in 32%. The mean time between liver transplant and first ERCP was: 19 ± 30 months in AS, 17 ± 30 months in NAS, 61 ± 28 months in BDS, and 0.7 ± 0.6 months in BL ( p < Resumo Introdução: As complicações biliares após transplante hepático são uma fonte importante de morbilidade e mortalidade. A colangiopancreatografia retrógrada endoscópi-ca (CPRE) é a primeira opção de tratamento em muitos casos, previamente a procedimentos mais invasivos. O objetivo deste trabalho foi avaliar a eficácia da CPRE no tratamento destas complicações. Doentes e métodos: Estudo retrospetivo de todos os doentes submetidos a CPRE terapêutica devido a complicações biliares após transplante hepático, entre setembro de 2005 e setembro de 2015. Resultados: Incluídos 120 doentes submetidos a CPRE terapêutica, sendo 64% do sexo masculino, com idade média de 46 ± 14 anos. Complicações biliares: estenose da anastomose (EA) em 70%, estenose não anastomótica (ENA) em 14%, coledocolitíase em 32% e fuga biliar (FB) em 5,8%. Tempo entre transplante e primeira CPRE (meses): 19 ± 30 nas EA, 17 ± 30 nas ENA, 61 ± 28 na coledocolitíase e 0,7 ± 0,6 na FB ( p < 0,001...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of Endoscopic Retrograde Cholangiopancreatography in the Treatment of Biliary Complications following Liver Transplant: 10 Years of a Single-Centre Experience

Alves¹,

Gomes²,

Furtado

et al. 2017

GE Port J Gastroenterol

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“…Because of the small caliber of the donor duct, a small diameter plastic stent was initially used to induce anastomotic dilatation and then multiple parallel plastic stents are gradually placed. The long‐term resolution rate of this method was about 89–98% and the recurrence rate was reported to be 6% . However, plastic stent‐based methods have disadvantages.…”

Section: Discussionmentioning

confidence: 96%

“…The inclusion criteria were as follows: admitted patients who had clinical symptoms of bile duct obstruction with jaundice, those who had documented ABS after LDLT, and those who had persistent biliary stricture after at least one endoscopic treatment with plastic stent(s) with or without balloon dilatation. Exclusion criteria were as follows: those who were under 18 years old or over 80 years old, contradictions to ERCP, suspected malignant biliary stricture, surgically altered gastrointestinal anatomy, bleeding tendency (platelet < 50 000/mm 3 or prothrombin time international normalized ratio > 1.5), and those who refused to participate in this study. Written informed consents for endoscopic procedure were obtained from all patients.…”

Section: Methodsmentioning

confidence: 99%

“…Because plastic stents have relatively short maintenance periods, they need to be replaced frequently . Sequential placement of plastic stents in increasing numbers every 2–3 months is often necessary to obtain complete resolution of the stricture . On the other hand, self‐expanding metal stent (SEMS) is larger in diameter than plastic stent.…”

Section: Introductionmentioning

confidence: 99%

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Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

Yoo

Lee

et al. 2019

J of Gastro and Hepatol

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Background and Aim Fully covered self‐expandable metallic stent (FCSEMS) may be an effective modality for managing anastomotic biliary stricture (ABS) after liver transplantation. However, stent migration and stent‐induced ductal injury are the main limitations. The objective of this study was to evaluate the usefulness of an unflared, intraductal FCSEMS that was designed to minimize migration and ductal injury for refractory ABS after living donor liver transplantation (LDLT). Methods A total of 32 consecutive patients with symptomatic ABS after LDLT unresolved by plastic stents with or without balloon dilation at four tertiary medical centers were prospectively enrolled. A short (3 or 5 cm) FCSEMS having long lasso (10 cm) used in this study had unflared convex ends to minimize tissue hyperplasia and smaller center portion to prevent migration. The FCSEMS was placed above the papilla and removed at 3–4 months after stenting. Results Technical and clinical success rates of intraductal placement with FCSEMS were 100% (32/32) and 81.2% (26/32), respectively. Early stent migration was observed in five (15.6%) patients. However, three patients with early stent migration had stricture resolution without needing additional intervention. Intended stent removal was successful in 27 (100%) patients (median, 101 days; range, 23–118 days). No stent‐induced ductal change was observed in all patients. Stricture recurrence was observed in 11.5% (3/26) of patients during 639 days of median duration of follow‐up (range, 366–2079 days). Conclusions Intraductal placement of an unflared short FCSEMS may be a promising option for refractory ABS after LDLT with minimal stent‐induced ductal injury and stent migration.

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Risk factors of post‐endoscopic retrograde cholangiopancreatography pancreatitis among living‐donor liver transplant recipients with biliary complications

Espinosa¹,

Chiu

Kuo

et al. 2021

Adv in Digestive Medicine

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The aim of this study is to investigate the incidence of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis (PEP) among living donor liver transplant (LDLT) recipients and the risk factors that may predispose to PEP. From December 2008 to August 2015, a total of 652 adult LDLT cases were performed at the Kaohsiung Chang Gung Memorial Hospital. LDLT recipients with biliary complications undergoing ERCP treatment were recruited in this study. PEP was assessed by using established consensus criteria. Patient-and procedure-related factors were collected and analyzed to investigate the association with PEP. A total of 62 (9.5%) patients developed biliary complications after LDLT and received 223 ERCP procedures. Initial ERCP treatments were successful in 58 (93.5%) patients, and 4 (6.5%) patients failing in biliary cannulation proceeded to rendezvous procedure successfully. Pancreatic duct (PD) injection had the highest incidence (23.5%) of PEP followed by a short interval between LT and ERCP (<12 weeks) (18.5%), creatinine >2 mg/dl (16.6%), initial ERCP (16.1%), precut EST (13.8%), EST (12.9%), and use of prednisone (8.9%). Univariate analysis showed that initial ERCP, precut EST, PD injection, a short interval between LT and ERCP, and use of prednisolone were associated with PEP. However, multivariate analysis revealed that only initial ERCP (OR 17.2, 95% CI 1.9-150.2) and PD injection (OR 5.4, 95% CI 1.2-24.7) were independent risk factors of PEP among LDLT recipients. LDLT recipients undergoing initial ERCP and PD injection of contrast during the procedure are at a high risk to develop PEP. Prophylactic strategies should be adopted especially in this subset of patients.

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Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results

Abstract: 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.

Cited by 47 publications

References 18 publications

Efficacy of Endoscopic Retrograde Cholangiopancreatography in the Treatment of Biliary Complications following Liver Transplant: 10 Years of a Single-Centre Experience

Efficacy of Endoscopic Retrograde Cholangiopancreatography in the Treatment of Biliary Complications following Liver Transplant: 10 Years of a Single-Centre Experience

Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

Risk factors of post‐endoscopic retrograde cholangiopancreatography pancreatitis among living‐donor liver transplant recipients with biliary complications

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