SEQUENTIAL MULTISTENTING TECHNIQUE FOR TREATING BILIARY ANASTOMOTIC STENOSIS FOLLOWING LIVER TRANSPLANTATION

Aims:

Biliary complications following liver transplantation (LT) range from 8% to 35%. Anastomotic stricture (AS) is the most common complication. Endoscopic Retrograde Cholangiography (ERC) with sphincterotomy and pneumatic dilation with multiple stents placement is the gold standard for treating AS.; ERC/stent exchange should be repeated every three months to get the morphological recovery of the stenosis. The success rate is approximately 70%-80%. In patients responding to endoscopic therapy, the risk of AS recurrence is around 18%. We describe sequential multistenting technique as a novel cost-effective strategy, in which one additional stent is placed during sequential ERCs, without stent removal/exchange.

Aims:

AS resolution, endpoint was no (or minimum) waist on cholangiography and a 12-mm extraction balloon could easily pass through the anastomosis. 2. Clinical success, as the AS resolution plus the normalization of cholestatic indices (CI) for more than one month following the last procedure. 3. Recurrence, diagnosed by an increase in the CI plus imaging tests diagnostic for stenosis. 4. Adverse events clinically related with endoscopic treatment.

Methods:

Prospective observational study at single tertiary center. All consecutive patients with diagnosis of AS after LT, underwent sequential multistenting therapy. The patients included in the analysis had at least 6 months of follow-up.

Results:

From May 2012 to May 2018, 88/395 patients who underwent LT, developed duct-to-duct anastomotic stricture. These patients were consecutively enrolled and treated with sequential multistenting technique. Initial stricture resolution was achieved in 87 patients (98.8%) and all of them showed normalization of CI after one month by the end of endotherapy. The mean follow-up time was 989.4 days (SD ± 619.2). During follow-up, seven adverse events (8%) (five cholangitis, one migration and one cholestasis) and seven recurrences (8%) were recorded.

Conclusions:

Current study shows, in a large cohort of patients with AS post-LT, the high efficacy and the low recurrence rate of sequential multistenting technique.