Endoscopy 2018; 50(04): S71
DOI: 10.1055/s-0038-1637237
ESGE Days 2018 oral presentations
21.04.2018 – ERCP 3: Hot topics and post liver transplantation
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC MANAGEMENT WITH PLASTIC STENTS OF NONANASTOMOTIC BILIARY STRICTURES FOLLOWING LIVER TRANSPLANTATION: A SINGLE CENTER EXPERIENCE

F Barbaro
1   Policlinico A. Gemelli – Catholic University of Rome, Rome, Italy
,
A Tringali
1   Policlinico A. Gemelli – Catholic University of Rome, Rome, Italy
,
A Baldan
2   Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Bergamo, Italy
,
I Boskoski
1   Policlinico A. Gemelli – Catholic University of Rome, Rome, Italy
,
P Familiari
1   Policlinico A. Gemelli – Catholic University of Rome, Rome, Italy
,
G Onder
1   Policlinico A. Gemelli – Catholic University of Rome, Rome, Italy
,
V Perri
1   Policlinico A. Gemelli – Catholic University of Rome, Rome, Italy
,
G Costamagna
1   Policlinico A. Gemelli – Catholic University of Rome, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

NonAnastomotic Biliary Strictures (NABS) following Liver Transplantation (OLT) are difficult to treat and show, in the few published studies, a significantly worse outcome when compared to Anastomotic Biliary Strictures (ABS). The long-term results of endoscopic treatment with plastic stents of NABS following OLT was analyzed.

Methods:

33 patients who underwent ERCP for NABS after OLT at our Endoscopy Unit between 1997 and 2015 were retrospectively identified. 9 patients were excluded from the analysis: 5 died with stents in place for unrelated causes and 4 patients did not complete the stenting period since they underwent Liver Retransplantation. 24 patients were finally included in the analysis

Results:

Median time from OLT to NABS diagnosis was 8.3 months. 8 patients were considered technical failure, since there was a failure to pass a guidewire across the stricture (n = 2) or the cases were considered not amenable to endoscopic treatment (n = 6); 4 patients died with stent in place for biliary sepsis. NABS resolution was obtained in 12/24 patients. The median duration of the endoscopic treatment was 10.1 months (4 ERCP/patient). Immediate ERCP-related adverse events occurred in 3/71 procedures. After a median follow-up of 5.9 years from stent removal 1/12 patients had NABS recurrence and was successfully retreated endoscopically. Considering potential predictors of NABS outcome, there is a variable that appeared to stand out: the time of onset of the disease. NABS occurring less than 12 months showed a worse prognosis.

Conclusions:

Even if with a significantly greater follow-up period, we reported similar successful stricture resolution rate than previously published studies. Early onset of NABS seems to be a prognostic factor of disease severity. Since many patients with NABS either die in need of a liver or require retransplantation as a consequence of graft loss, endotherapy could be a safe and effective treatment strategy bridge-to-surgery.