Outcome of ERCP in the Management of Duct-to-Duct Anastomotic Strictures in Orthotopic Liver Transplant

Abstract

This study sought to determine the efficacy of endoscopic treatment of duct-to-duct anastomotic stricture in orthotopic liver transplant. A retrospective chart and database review was carried out using procedure and diagnosis codes during the period of 1997-2001. One hundred ninety-eight adult patients underwent orthotopic liver transplantation from 1997 to 2001. Fifteen patients (age 52+/-9 years; 60% women) with duct-to-duct anastomotic strictures were identified. They underwent a total of 53 endoscopic retrograde cholangiopancreatographies (ERCPs) and received different endoscopic treatments including biliary dilation, stent placement, and sphinctrerotomy. Thirteen of these patients (87%) had complete resolution of stricture. Of the remaining two patients, one had partial resolution of stricture and underwent long-term self-expanding metal stenting, while the other had no resolution after two ERCPs. We conclude that ERCP was effective in treating 87% of the duct-to-duct anastomotic strictures in this series.

Long-term outcome of endoscopic and/or percutaneous transhepatic therapy in patients with biliary stricture after orthotopic liver transplantation

“…These results are in line with another published report [23]. However, in contrast several other authors reported a shorter [24] or longer [4,5,9,25] time period from liver transplantation to the development of biliary stricture. Similar to our series, Graziadei et al [4] distinguished between anastomotic and non-anastomotic strictures after liver transplantation.…”

“…The median duration of successful therapy was respectively 9, 11 and 10 months. Several other authors also reported successful endoscopic and/or percutaneous transhepatic therapy in most patients with biliary stricture after liver transplantation [4,12,[23][24][25]. Holt et al [12] observed in a prospective study design 791 adults who underwent liver transplantation; 53 out of 791 patients were diagnosed with biliary anastomotic stricture.…”

Endoscopic treatment of anastomotic biliary stricture after adult deceased donor liver transplantation with multiple plastic stents versus self-expandable metal stents: a systematic review and meta-analysis

“…There is no consensus on this treatment, with some authors supporting alternative timing while others preferring single stents or dilation alone to minimize complications . However, this strategy requires repeated hospital admissions and endoscopic procedures and exposes patients to ERCP‐associated morbidity . Kobayashi et al .…”

Clinical outcome of endoscopic covered metal stenting for resolution of benign biliary stricture: Systematic review and meta‐analysis

“…Increasing the number of plastic stents (PS) will progressively dilate a stricture of the common bile duct (CBD) or major papilla . Placement of MPS has been revealed to be effective in managing BBS with stricture resolution rates ranging from 78% to 85% . Main drawbacks are need for frequent stent exchange, either scheduled tri‐monthly or unscheduled after stent occlusion, and relative technical challenge in inserting multiple stents side‐by‐side across the stricture …”