Faculty Collaboration Database

Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video). Gastrointest Endosc 2010 Mar;71(3):505-12

Date

03/02/2010

Pubmed ID

20189508

DOI

10.1016/j.gie.2009.10.023

Scopus ID

2-s2.0-77249142395 (requires institutional sign-in at Scopus site)   108 Citations

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.

Author List

Tabibian JH, Asham EH, Han S, Saab S, Tong MJ, Goldstein L, Busuttil RW, Durazo FA

Author

Francisco A. Durazo MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Anastomosis, Surgical
Bile Ducts
Catheterization
Cholangiopancreatography, Endoscopic Retrograde
Constriction, Pathologic
Humans
Liver Transplantation
Middle Aged
Retrospective Studies
Stents
Video Recording