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Endoscopy 2013; 45(07): 567-570
DOI: 10.1055/s-0032-1326411
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Clinical outcome of progressive stenting in patients with anastomotic strictures after orthotopic liver transplantation

J. W. Poley
  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
M. N. Lekkerkerker
  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
H. J. Metselaar
  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
E. J. Kuipers
  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
M. J. Bruno
  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 03 July 2012

accepted after revision 05 February 2013

Publication Date:
11 April 2013 (online)

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Commentaire de travail de Poley JW et al., pp. 567Endoscopy 2013; 45(07): 685-685
DOI: 10.1055/s-0033-1344601

Background and study aims: Anastomotic strictures are an important cause of morbidity after orthotopic liver transplantation (OLT). Endoscopic treatment is the primary treatment modality for biliary complications after OLT. The outcome and complications of a progressive stenting protocol are largely unknown.

Patients and methods: A longitudinal cohort study of OLTs was conducted. Only patients with late strictures were included. Treatment success was defined as cholangiographic stricture resolution and liver enzymes returning to normal with follow-up of at least 12 months.

Results: Between May 2000 and June 2009, 375 OLTs were performed. A duct-to-duct anastomosis was created in 304 cases (81 %). In 63 patients (21 %; 95 % confidence interval [CI] 16.5 % – 25.6 %) an anastomotic stricture developed and progressive stenting was started in 35. During treatment two patients died of a non-treatment-related cause and two patients underwent a second OLT during stent therapy. Therefore 31 patients were available for analysis (male : female 21:10; median age 61 years, range 28 – 75 years). Progressive stenting required a median number of 5 endoscopic retrograde cholangiopancreatography (ERCP) procedures (range 4 – 11). A median maximum of 4 stents (range 2 – 8) were inserted. A total of 21 patients (67.7 %; 95 %CI 50.1 % – 81.4 %) developed a treatment-related complication. In 33 out of a total of 155 ERCPs (21.3 %) a complication occurred: cholangitis (n = 12), transient cholestasis (n = 11), post-ERCP pancreatitis (n = 7), and treatment-related pain (n = 3). The median follow-up time after stent removal was 28 months (range 12 – 92). Treatment was successful in 25 patients (80.6 %; 95 %CI 63.7 % – 90.8 %).

Conclusion: Progressive stenting for anastomotic strictures after OLT is demanding and burdensome, necessitating a median of 5 ERCP procedures with complications occurring in one out of five procedures. Its success rate however is high (81 %), avoiding surgery in the large majority of patients.

 

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