Introduction Biliary anastomotic strictures are a frequent complication of liver transplantation (LT), that is associated with important morbidity and high costs. ERCP is considered the treatment of choice, however, the optimal management of these patients has not yet been shown.
Objective To evaluate the efficacy and complicaitons of endoscopic treatment with ERCP of patients with LT and stricture of biliary anastomosis, and to identify predictors of good response to endoscopic treatment.
Method Retrospective study, which included all patients with previous history of LT and subsequent diagnosis of biliary anastomotic stenosis and underwent ERCP between January 2002 and December 2013. Good response was defined as total resolution of the stricture with no need of further interventions.
Results 103 patients were included in the study, 79 (77%) were men, mean age of 53 years (range 35 to 70 years). The most frequent indications for LT were hepatocellular carcinoma (33%), alcoholic cirrosis (20.4%) and hepatitis C (18%). 44% of the patients presented early anastomotic stricture, that developed after a mean time of 79 weeks after LT. Furthermore, 4% of the patients associated a biliary fistula. The mean number of ERCP sessions was 3,4 (range 1–10), with mean success rate of 80%. As for the endoscopic technique, endoscopic dilatation was performed in 77% of cases (mean number of dilatations of 1,9); plastic stent was placed in 73% (average 3,9 stents per patient), and in 16% of the patients, plastic stents were initially placed and changed for metalic stents in subsequent ERCPs (1,5 stents per patient). The complication rate was of 9,1%: migration of stent was observed in 11 cases (10 plastic stents and 1 metal stent); colangitis/bacteriaemia in 3,1%, pancreatitis in 3,1%, bleeding in 1,1% and perforation in 0,3%. Two patients died as a direct complication of ERCP, both due to pancreatitis.
57 patients (55%) presented complete response to endoscopic treatment, with posterior reappearance of stricture in 11 (11%) cases, and 31 patients did not respond, 17 of those underwent surgery.
Conclusion In our experience, ERCP is a reasonably safe technique of treatment of biliary strictures in LT patients, that can avoid surgical procedures in a high proportion of them.
Disclosure of interest None Declared.
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