Abstract
Background Biliary complications are a serious source of morbidity after orthotopic and living-related
liver transplantation. Endoscopic retrograde cholangiography (ERC) is the gold standard
for patients with duct-to-duct anastomosis because it allows a direct approach for
interventional procedures. A retrospective study showed results of a sequential multistenting
protocol, without stent removal/exchange, with promising results. We conducted a prospective
analysis to assess the clinical success, recurrence rate, and adverse event rate related
to this protocol.
Methods From May 2012 to April 2018, all consecutive patients with a diagnosis of anastomotic
stenosis following liver transplantation were enrolled in the study, and were followed
for a period of at least 6 months after the last ERC. During the first ERC, a maximum
number of plastic stents (10 Fr) were placed. In subsequent ERCs, scheduled every
3 months up to a maximum of 1 year, additional stents were inserted, as many as possible,
without removing the previously placed stents.
Results From May 2012 to May 2018, 87 patients were included in the study and treated with
a sequential multistenting protocol. The mean number of stents placed was 3.7 (SD
1.0). Clinical success (stricture resolution and normalization of cholestasis) was
achieved in 86 patients (98.9 %). Seven patients (8.0 %) developed complications.
Recurrence was recorded in seven patients (8.0 %) after a mean of 992.7 days (SD 622.1).
Conclusions This study represents the first prospective demonstration of the efficacy and safety
of a sequential multistenting protocol. A key limitation of the study is the lack
of a comparative group treated according to the traditional stent exchange approach.
