Recurrence Rate of Anastomotic Biliary Strictures in Patients who have had Previous Successful Endoscopic Therapy for Anastomotic Narrowing after Orthotopic Liver Transplantation

Alazmi, Waleed; Fogel, Evan L.; Watkins, James L.; McHenry, Lee; Tector, Joseph; Fridell, J. A.; Mosler, Patrick; Sherman, Stuart; Lehman, Glen A.

doi:10.1055/s-2006-925027

Cited by 107 publications

(68 citation statements)

References 6 publications

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“…An increasing number of stents can be used at each session to achieve a maximum diameter. The majority of patients require several endoscopic interventions, with a mean of 3 to 5 with long term success rates in the range of 70%-100% [3,32,36,37,68,69,[71][72][73][74] . A protocol of accelerated dilation every 2 wk, and a shortened stenting period of an average of 3.6 mo, showed some encouraging results with a high 87% success rate [68] .…”

Section: Diagnosismentioning

confidence: 99%

Endoscopic management of biliary strictures after liver transplantation

Williams¹,

Draganov²

2009

WJG

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Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classified as anastomotic or non-anastomotic strictures according to location and are defined by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is significant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.

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Section: Diagnosismentioning

confidence: 99%

Endoscopic management of biliary strictures after liver transplantation

Williams¹,

Draganov²

2009

WJG

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“…Significantly, more recurrences were seen in the patients who developed AS after more than 6 months after orthotopic liver transplantation compared to those with AS in the first 6 months . Recurrence rate of post-anastomotic biliary strictures was reported by Alzami et al to be relatively small (18%) over a follow-up period of almost 3 years (Alazmi et al, 2006), while others reported to be around 10%-13% (Morelli et al, 2003). They concluded that recurrence could be effectively diagnosed and treated by endosopic approach requiring between one and four additional sessions.…”

Section: Deceased Donor Liver Transplantation (Ddlt)mentioning

confidence: 93%

“…Factors found to be associated with poor outcome and/or higher recurrence following endoscopic treatment or stent removal include delayed initial presentation (more than 6 months after transplantation), presence of tight strictures (Alazmi et al, 2006;Verdonk et al, 2007), presence of bile leaks, and use of T tubes (Sharma et al, 2008;Alazmi et al, 2006). The conventional method of endoscopic treatment comprises of stricture localization followed by guidewire cannulation, balloon dilatation, and subsequent placement of plastic stents.…”

Section: Deceased Donor Liver Transplantation (Ddlt)mentioning

confidence: 99%

“…The majority of patients with anastomotic strictures will require several endoscopic interventions every 3 months with a mean of 3 to 5 sessions, using balloon dilation of 6-10 mm and multiple stents of 7 Fr to 10 Fr repeated for 12-24 months (Morelli et al, 2003;Thuluvath et al, 2005). The long-term success rates were in the range of 70%-100% (Alazmi et al, 2006;Morelli et al, 2003;Rerknimitr et al, 2002;Verdonk et al, 2006). A small group of patients, with transient anastomotic narrowing during the first 1-2 month post transplant, presumably due to postoperative edema, may respond with a single session of endoscopic balloon dilatation and plastic stent placement with no need for further intervention ).…”

Section: Deceased Donor Liver Transplantation (Ddlt)mentioning

confidence: 99%

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Endoscopic Management of Biliary Complications After Liver Transplantation

Eldeen¹,

Lee²,

Lee³

2011

Therapeutic Gastrointestinal Endoscopy

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“…They tend to occur earlier than AS with mean time of presentation 3-6 mo post-LT and have an incidence of 5%-15% [23,24] . Although most NAS are multifactorial, to hepatic artery thrombosis (HAT) leading to biliary destruction; (2) microangiopathic -secondary to they can further be divided into 3 sub-types based on their etiology: (1) macroangiopathic -secondary studies for DDLT [32,[35][36][37][38] but decreases to 37%-71% in patients with LDLT [39,40] because of the more complex duct-to-duct anastomosis. Factors limiting efficacy include peripheral location and presence of smaller and multiple biliary anastomotic strictures.…”

Section: Biliary Stricturesmentioning

confidence: 99%

Endoscopic management of post-liver transplant biliary complications

Girotra¹,

Soota²,

Klair³

et al. 2015

WJGE

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Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques that have proved endoscopic retrograde cholangiography with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also discuss the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality. Core tip: Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques which have proved ERCP with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also deliberate the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality.

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Recurrence Rate of Anastomotic Biliary Strictures in Patients who have had Previous Successful Endoscopic Therapy for Anastomotic Narrowing after Orthotopic Liver Transplantation

Cited by 107 publications

References 6 publications

Endoscopic management of biliary strictures after liver transplantation

Endoscopic management of biliary strictures after liver transplantation

Endoscopic Management of Biliary Complications After Liver Transplantation

Endoscopic management of post-liver transplant biliary complications

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