Aims Anastomotic biliary strictures (ABS) are a common complication following orthoptic liver transplant (OLT) occurring in 4.5-15 % after deceased donor LT. ERCP and stent placement has become the preferred initial treatment although a standard approach has not been established with regards to stent type, single vs. multiple stent placement, and the role of dilation.
Methods All OLTs performed from 1/1/2012 to 1/2/2020 in the Irish National Liver Transplant Centre were correlated with ERCPs performed in the same unit to identify patients who developed ABS requiring endoscopic intervention. Type of intervention and long-term outcomes were analysed retrospectively.
Results 459 OLTs, including 28 re-transplants, were performed during the study period. 16 patients (3.5 %) were referred for ERCP due to ABS after a median of 93 days (IQR 17.5-148) post OLT. At initial ERCP, 15/16 procedures (94 %) were technically successful (1 dilatation, 3 FC-SEMS, 11 PS) while 1/16 failed and required PTC and later hepaticojejunostomy. 2/15 subsequently died prior to stent removal due to chronic rejection and recurrent cholangiopathy. In the remaining 13 patients who had successful ERCP and had follow-up data available, 7/13 (53 %) had stricture resolution and stent removal after a median of 3 procedures (IQR 3-5). The use of FC-SEMS was associated with significantly improved rates of stricture resolution (p-value 0.026). All 7 cases of stricture resolution had FC-SEMS insertion, 1 at index ERCP and 6 following initial PS insertion. 2 procedure-related complications were observed, 1 biliary perforation and 1 proximally migrated plastic stent requiring PTC. No complications were observed with the use of FC-SEMS.
Conclusions ERCP and stenting resulted in stricture resolution in over half of patients with ABS, and only in cases where FC-SEMS was placed.
FC-SEMS is safer and significantly more effective than PS in the treatment of post-OLT ABS. Larger, prospective studies are required to further support these findings.
Citation
Storan D, Fennessy S, Doherty GA et al. eP336 ENDOSCOPIC MANAGEMENT OF POST LIVER TRANSPLANT ANASTOMOTIC BILIARY STRICTURES - THE IRISH EXPERIENCE. Endoscopy 2021; 53: S207.
