Endoscopic Management of Benign Biliary Strictures After Liver Transplantation

Abstract

Biliary strictures represent some of the most frequent complications encountered after orthotopic liver transplantation. They comprise an array of biliary abnormalities with variations in anatomical location, clinical presentation, and different pathogenesis. Magnetic resonance cholangiography represents the most accurate noninvasive imaging test that can provide detailed imaging of the whole biliary system—below and above the anastomosis. It is of particular value in those harboring complex hilar or intrahepatic strictures, offering a detailed roadmap for planning therapeutic procedures. Endoscopic therapy of biliary strictures usually requires biliary sphincterotomy plus balloon dilation and stent placement. However, endoscopic management of nonanastomotic biliary strictures is much more complex and challenging as compared with anastomotic biliary strictures. The present article is a narrative review presenting the results of endoscopic treatment of biliary strictures occurring after liver transplantation, describing the different strategies based on the nature of the stricture and summarizing their outcomes.

Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

“…The procedure of ERCP is more difficult for patients with LDLT than that for patients with other etiologies of ABS due to the complex nature of duct-to-duct reconstruction on the perihilar region. 2 For this reason, the success rate of stricture resolution is significantly lower in patients with ABS after LDLT than that after deceased donor liver transplantation (DDLT). 2 Therefore, an advanced technique with selection of an Because of the small caliber of the donor duct, a small diameter plastic stent was initially used to induce anastomotic dilatation and then multiple parallel plastic stents are gradually placed.…”

“…2 For this reason, the success rate of stricture resolution is significantly lower in patients with ABS after LDLT than that after deceased donor liver transplantation (DDLT). 2 Therefore, an advanced technique with selection of an Because of the small caliber of the donor duct, a small diameter plastic stent was initially used to induce anastomotic dilatation and then multiple parallel plastic stents are gradually placed. The longterm resolution rate of this method was about 89-98% and the recurrence rate was reported to be 6%.…”

“…This was a multicenter, prospective, non‐randomized clinical trial at four tertiary referral hospitals performed from January 2013 to January 2017. The inclusion criteria were as follows: admitted patients who had clinical symptoms of bile duct obstruction with jaundice, those who had documented ABS after LDLT, and those who had persistent biliary stricture after at least one endoscopic treatment with plastic stent(s) with or without balloon dilatation. Exclusion criteria were as follows: those who were under 18 years old or over 80 years old, contradictions to ERCP, suspected malignant biliary stricture, surgically altered gastrointestinal anatomy, bleeding tendency (platelet < 50 000/mm 3 or prothrombin time international normalized ratio > 1.5), and those who refused to participate in this study.…”

“…In general, the use of plastic stent with or without balloon dilatation is a common and widely spread treatment. Because plastic stents have relatively short maintenance periods, they need to be replaced frequently . Sequential placement of plastic stents in increasing numbers every 2–3 months is often necessary to obtain complete resolution of the stricture .…”

“…Because plastic stents have relatively short maintenance periods, they need to be replaced frequently. 2 Sequential placement of plastic stents in increasing numbers every 2-3 months is often necessary to obtain complete resolution of the stricture. 3,4 On the other hand, self-expanding metal stent (SEMS) is larger in diameter than plastic stent.…”