Endo-therapies for biliary duct-to-duct anastomotic stricture after liver transplantation: outcomes of a nationwide survey

Paolo Cantù, Ilaria Tarantino, Anna Baldan, Massimiliano Mutignani, Andrea Tringali, Giovanni Lombardi, Angelo Cerofolini, Antonio Di Sario, Giorgia Catalano, Helga Bertani, Davide Ghinolfi, Valentina Boarino, Enzo Masci, Milutin Bulajic, Antonio Pisani, Alberto Fantin, Dario Ligresti, Luca Barresi, Mario Traina, Paolo RavelliEdoardo Forti, Federico Barbaro, Guido Costamagna, Luca Rodella, Luca Maroni, Mauro Salizzoni, Rita Conigliaro, Franco Filipponi, Alberto Merighi, Teresa Staiano, Michela Monteleone, Vincenzo Mazzaferro, Elena Zucchi, Maurizio Zilli, Elena Nadal, Roberto Rosa, Giulio Santi, Ilaria Parzanese, Luciano De Carlis, Maria Francesca Donato, Pietro Lampertico, Umberto Maggi, Lucio Caccamo, Giorgio Rossi, Maurizio Vecchi, Roberto Penagini

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The most appropriate endo-therapeutic approach to biliary anastomotic strictures is yet to be defined.

AIM: To retrospectively report on the endo-therapy of duct-to-duct anastomotic strictures during 2013 in Italy.

METHODS: Data were collected from 16 Endoscopy Units at the Italian Liver Transplantation Centers (BASALT study group).

RESULTS: Complete endo-therapy and follow-up data are available for 181 patients: 101 treated with plastic multistenting, 26 with fully covered self-expandable metal stenting (SEMS) and 54 with single stenting. Radiological success was achieved for 145 patients (80%), i.e. 88% of plastic multistenting, 88% of SEMS and 61% of single stenting (p<0.001 vs plastic multistenting; p<0.05 vs SEMS)]. After first-line endo-therapy failure, the patients underwent a second-line endo-therapy with plastic multistenting for 25%, fully covered SEMS for 53% and single stenting for 22% of cases, and radiological success was achieved for 84%, i.e. 100%, 85%, and 63% with plastic multistenting, SEMS and single stenting (p<0.05 vs plastic multistenting or SEMS), respectively. Procedure-related complications occurred in 7.8% of ERCP. Overall clinical success was achieved in 87% of patients after a median follow-up of 25 months.

CONCLUSION: Plastic multistenting is confirmed as the preferred first-line treatment, while fully covered SEMS as rescue option for biliary anastomotic strictures. Single stenting has sub-optimal results and should be abandoned. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalLiver International
DOIs
Publication statusE-pub ahead of print - Nov 30 2018

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