ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

Abstract

-Context -Biliary strictures after liver transplantation are recognized as its Achilles' heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objective -The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation.

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

“…management after liver transplantation has not yet been found to present an advantage over plastic stents, although it seems to be a promising procedure. Similarly, no controlled, randomized clinical trial was found through the systematic review conducted by Nacif et al 54 concerning outcomes from endoscopic AS treatment after liver transplantation, but only prospective and retrospective comparative studies. Studies comparing endoscopic with percutaneous access were included and similar clinical success rates for both groups were found, with longer treatment time in the percutaneous access group.…”

Endoscopic management of non‐anastomotic biliary strictures following liver transplantation: Long‐term results from a single‐center experience

“…Endoscopic dilatation with progressive insertion of an increasing number of plastic biliary stents (multistenting technique) until morphological resolution of the stricture is obtained, has become the standard treatment of this OLT complication, with 85-90% resolution rates. [4][5][6] Differently, NABS occurring after OLT are less frequent than ABS, are associated with substantial morbidity, and have a multifactorial etiology such as hepatic artery thrombosis, prolonged cold and warm ischemic time, reperfusion injury, pretransplant diagnosis of primary sclerosing cholangitis, cytomegalovirus (CMV) infection, ABO incompatibility, and rejection. [7][8][9][10][11][12][13][14] The etiological factor responsible for the development of NABS seems to determine the subtype of stenosis.…”

“…They are usually solitary and short in length. Endoscopic dilatation with progressive insertion of an increasing number of plastic biliary stents (multistenting technique) until morphological resolution of the stricture is obtained, has become the standard treatment of this OLT complication, with 85–90% resolution rates 4–6 …”

Long‐term outcomes of early compared to late onset choledochocholedochal anastomotic strictures after orthotopic liver transplantation

“…Although ABS may initially present in a manner similar to NAS (jaundice, cholestatic elevation of LFTs, cholangitis), they are characteristically found on ERCP to be shorter in length, solitary, and adjacent to the anastomotic site. ERCP has been shown to be effective in the management of ABS and while patients with stenotic disease were often treated surgically a few decades ago, their first line of management is now ERCP with short‐term stent placement with or without balloon dilation . Long‐term stricture resolution with endoscopic intervention is highly probable, although might need multiple, sometimes progressive stenting to achieve optimal success .…”