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Endoscopy 2016; 48(06): 546-551
DOI: 10.1055/s-0042-100277
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results

Andrea Tringali
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Federico Barbaro
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Margherita Pizzicannella
2   Surgical Department, Campus Bio Medico University Hospital, Rome, Italy
,
Ivo Boškoski
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Pietro Familiari
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Vincenzo Perri
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Giovanni Gigante
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Graziano Onder
3   Department of Geriatrics, Catholic University, Gemelli University Hospital, Rome, Italy
,
Cesare Hassan
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
,
Raffaella Lionetti
4   Hepatology Unit, National Institute for Infectious Diseases, L. Spallanzani Hospital, Rome, Italy
,
Giuseppe Maria Ettorre
5   General Surgery and Transplantation Unit, San Camillo Hospital, Rome, Italy
,
Guido Costamagna
1   Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy
6   IHU, USIAS Strasbourg University, Strasbourg, France
› Author Affiliations
Further Information

Publication History

submitted 04 June 2015

accepted after revision 07 December 2015

Publication Date:
09 February 2016 (online)

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Background and aims: Anastomotic biliary stricture (ABS) is the most common biliary complication after orthotopic liver transplantation (OLT) and can be successfully managed endoscopically. The long-term results of a protocol using placement of multiple plastic stents to treat ABS following OLT were analyzed.

Methods: All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for OLT-related biliary complications at our Endoscopy Unit between July 1994 and March 2012 were retrospectively identified from the ERCP database. Patients with an ABS treated with an increasing number of plastic stents were included in the study. Follow-up after stent removal was obtained by telephone contact with the patient and/or referring physician and by liver function tests (LFTs) evaluation.

Results: 56 patients, treated with an increasing number of plastic stents until resolution of the stricture, were included. Five patients were then excluded (unrelated death during treatment, n = 3; incomplete treatment because of poor compliance, n = 2), and 51/56 patients reached study end points and were included in the analysis. Resolution of ABS was obtained in 50/51 patients; 1 patient required hepaticojejunostomy because of failure to pass the stricture with the guidewire (per protocol resolution, 98 %). Mean duration of endoscopic treatment was 11.5 months, with a median 4 ERCPs per patient. Immediate ERCP-related adverse events occurred in 3/56 patients (5.4 %). After a median follow-up of 5.8 years from stent removal, 3/50 patients (6 %) had recurrence of ABS. These 3 patients were successfully treated again endoscopically and are asymptomatic after a further median follow-up of 5.6 years.

Conclusions: At long-term follow-up, endoscopic treatment with multiple plastic stents of ABS following OLT appeared to be effective in most patients. Stricture recurrence is rare and can be successfully treated again endoscopically.

 

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