THE ROLE OF ENDOSCOPIC MANAGEMENT OF POST ORTHOTOPIC LIVER TRANSPLANT ANASTOMOTIC STRICTURES: EXPERIENCE IN A TERTIARY TRANSPLANT CENTRE

Aims To determine the effect of endoscopic management on post orthotopic liver transplant (OLT) anastomotic strictures.

Methods A retrospective review of the incidence and treatment of post OLT anastomotic strictures a tertiary transplant centre. Post OLT anastomotic strictures were analysed for rate of ERCP procedure success and incidence of stricture resolution versus surgery.

Results 386 OLTs were performed between 2014 and 2020. 28 (7%) were referred for ERCP due to anastomotic stricture. Median age at OLT 57 years; female n=9 (32%). The median interval from OLT to ERCP was 21 weeks (range 1-159). Successful stent placement at initial ERCP was achieved in 22 (79%) with an overall success rate of 93% following repeat ERCP. Strictures resolved in 12 (43%), while 10 (36%) were referred for hepaticojejunostomy because of continued stricturing. Two patients (7%) died with their stent in-situ while 4 (14%) remain under active management. Median number of procedures in stricture resolution versus the surgical cohort was 3 vs 2, and median time from initial ERCP to stricture resolution 27 weeks (range 0 – 82) in those with endoscopic success. There was no statistical difference in stricture resolution with or without use of self-expanding metal stent; 7 of 11(64%) vs 5 of 9 (56%) with plastic stents (Fisher’s exact test; p=1.00).

Conclusions Despite satisfactory technical success of ERCP in most post OLT anastomotic strictures (93%), a high portion of patients were ultimately resistant to endoscopic therapy and subsequently required surgical intervention. Use of SEMS did not improve stricture resolution.

Publication History

Article published online:
14 April 2022