Aims:
No clear data are available about long-term outcomes after endotherapy for Biliary Cast Syndrome (BCS) after OLT
Assess the clinical outcomes of endoscopic treatment, trying to classify the patients in morphological groups.
Methods:
All consecutive patients undergoing OLT, who needed an ERCP from March 2012 to December 2016, were retrospectively enrolled. Patients with endoscopic findings of BCS have been included. Primary outcomes were patient survival and need of a re-transplantation (re-OLT). Secondary outcomes were technical success, clinical success and onset of complications. Technical success is defined as successful cast extraction and/or treatment of the stricture (dilation ± stenting). Clinical success is defined as the survival, free of the need of a new ERCP, PTC or re-OLT, in the 6 months following the last procedure. We categorized patients into 4 groups according to the morphologic and endoscopic appearance.
Results:
Overall, 145 ERCP on 35 patients with BCS have been performed; occurred 8 deaths (22.8%) and two patients (5.7%) undergone re-OLT resulted still alive. Technical success was achieved in 112 procedures (77.2%); clinical success rate was 74.2%. Procedural complications occurred in 2 patients (5,6%): one bleeding and one mild post-ERCP pancreatitis. No perforation occurred. Almost half of the patients (54%), developed an infectious complication: acute cholangitis occurred in 11 patients (31.4%), and in 8 cases (22.8%) a sepsis. Clinical success group showed a lower mortality, compared to clinical failure group (7.6% vs. 66.6%, p = 0.001); moreover, clinical success was associated with a reduced need for re-OLT, without statistical significance (p = 0.15).
Differences in primary and secondary outcomes found among four groups of our classification did not reach the statistical significance for the small dimension of our sample
Conclusions:
Clinical success in endoscopic treatment resulted in a reduced mortality and need for re-OLT. This is the first study that correlates morphological patterns of BCS with clinical outcomes.
