Biliary Strictures After Liver Transplantation. Predictive Factors for Response to Endoscopic Management and Long-term Outcome.

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Biliary Strictures After Liver Transplantation. Predictive Factors for Response to Endoscopic Management and Long-term Outcome.

Articles American Journal of the Medical Sciences. 335(6):439-443, June 2008.BARRIGA, JOSE MD; THOMPSON, ROY MD; SHOKOUH-AMIRI, HOSEIN MD; DAVILA, RENA MD; ISMAIL, MOHAMMAD K. MD; WATERS, BRADFORD MD; TOMBAZZI, CLAUDIO R. MD

Abstract: Background: Biliary strictures after liver transplantation are frequent. The long-term prognosis and predictive factors of response to endoscopic treatment are not well known. Methods: The aim of this study was to demonstrate the role of endoscopic treatment, predictive factors of response, and outcome in patients with biliary stricture after liver transplantation. We performed a retrospective review of medical records of all consecutive post-liver transplantation patients who underwent endoscopic retrograde cholangiography in our center during the period from October 2001 to October 2006. Results: Twenty-five of 43 patients referred for endoscopic retrograde cholangiography had biliary stricture. Eighteen had stricture at the area of the anastomosis alone, 2 patients had a stricture at the area of the anastomosis and also another area, and 5 had nonanastomotic biliary strictures. Twenty-one patients had a single stricture and 4 had more than 1 stricture. Initially 19 of 24 patients (79%) responded to endoscopic management with normalization of liver enzymes. Four patients (16%) did not respond clinically despite a successful endoscopic approach. All patients who did not respond to endoscopic dilation had more than 1 area of stricture. There was a significantly better response to endoscopic treatment in patients with an anastomotic stricture versus patients with nonanastomotic strictures 17/19 versus 2/5 (P = 0.042). Conclusions: In our experience, endoscopic treatment of anastomotic biliary strictures is highly effective with a good long-term outcome. The presence of nonanastomotic and multiple strictures should be considered a factor associated with poor response to endoscopic management. © Copyright 2008 Southern Society for Clinical Investigation