TY - JOUR
T1 - ERCP and short-term stent-trial in patients with anastomotic biliary stricture following liver transplantation
AU - Cantù, P.
AU - Tenca, A.
AU - Donato, M. F.
AU - Rossi, G.
AU - Forzenigo, L.
AU - Piodi, L.
AU - Rigamonti, C.
AU - Agnelli, F.
AU - Biondetti, P.
AU - Conte, D.
AU - Penagini, R.
PY - 2009/7
Y1 - 2009/7
N2 - Background: Anastomotic biliary stricture represents one of the possible factors leading to liver dysfunction after transplantation. Purpose: Our aims were to evaluate the role of endoscopic retrograde cholangio-pancreatography and a short-term stenting (stent-trial) in assessment of the clinical relevance of the biliary stricture. Materials and methods: Thirty transplanted patients for HCV (n = 17) or non-HCV (n = 13)-related cirrhosis (27 M, median age 53 yr, range 24-67 yr) who developed persistently abnormal liver function tests and presented with an anastomotic biliary stricture suggested by non-invasive cholangiography, underwent endoscopic retrograde cholangio-pancreatography. If the stricture was confirmed, dilation was performed and a plastic stent was placed. Clinical and biochemical evaluation was done one and two months later. Resolution of symptoms and normalization or > 50% reduction of at least one liver function test were needed to consider the stricture as clinically relevant. Patients were followed up for a median of 19 months. Results: Endoscopic retrograde cholangio-pancreatography was successful in 29 patients and confirmed the anastomotic biliary stricture in 19 (66%); 14 patients underwent endoscopic dilation and stenting and five patients underwent surgery. The stent-trial suggested the stricture to be clinically relevant in 7 of 14 patients, confirmed by prolonged stenting and follow-up. A trend towards a higher likelihood of a clinically relevant stricture was observed in HCV-negative compared to HCV-positive patients (5 of 7, 71% vs 2 of 7, 29%, respectively; p = 0.1). Conclusions: Our data suggest that endoscopic retrograde cholangio-pancreatography is a valuable tool to evaluate the clinical relevance of an anastomotic stricture, when coupled with a short-term stent-trial.
AB - Background: Anastomotic biliary stricture represents one of the possible factors leading to liver dysfunction after transplantation. Purpose: Our aims were to evaluate the role of endoscopic retrograde cholangio-pancreatography and a short-term stenting (stent-trial) in assessment of the clinical relevance of the biliary stricture. Materials and methods: Thirty transplanted patients for HCV (n = 17) or non-HCV (n = 13)-related cirrhosis (27 M, median age 53 yr, range 24-67 yr) who developed persistently abnormal liver function tests and presented with an anastomotic biliary stricture suggested by non-invasive cholangiography, underwent endoscopic retrograde cholangio-pancreatography. If the stricture was confirmed, dilation was performed and a plastic stent was placed. Clinical and biochemical evaluation was done one and two months later. Resolution of symptoms and normalization or > 50% reduction of at least one liver function test were needed to consider the stricture as clinically relevant. Patients were followed up for a median of 19 months. Results: Endoscopic retrograde cholangio-pancreatography was successful in 29 patients and confirmed the anastomotic biliary stricture in 19 (66%); 14 patients underwent endoscopic dilation and stenting and five patients underwent surgery. The stent-trial suggested the stricture to be clinically relevant in 7 of 14 patients, confirmed by prolonged stenting and follow-up. A trend towards a higher likelihood of a clinically relevant stricture was observed in HCV-negative compared to HCV-positive patients (5 of 7, 71% vs 2 of 7, 29%, respectively; p = 0.1). Conclusions: Our data suggest that endoscopic retrograde cholangio-pancreatography is a valuable tool to evaluate the clinical relevance of an anastomotic stricture, when coupled with a short-term stent-trial.
KW - Anastomotic stricture
KW - Biliary stenting
KW - ERCP
KW - Liver transplantation
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U2 - 10.1016/j.dld.2008.08.002
DO - 10.1016/j.dld.2008.08.002
M3 - Article
C2 - 18838317
AN - SCOPUS:67349267820
VL - 41
SP - 516
EP - 522
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
IS - 7
ER -