Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results

Andrea Tringali; Federico Barbaro; Margherita Pizzicannella; Ivo Boškoski; Pietro Familiari; Vincenzo Perri; Giovanni Gigante; Graziano Onder; Cesare Hassan; Raffaella Lionetti; Giuseppe Maria Ettorre; Guido Costamagna

doi:10.1055/s-0042-100277

Endoscopy, Table of Contents

Endoscopy 2016; 48(06): 546-551
DOI: 10.1055/s-0042-100277

Original article

Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results

Andrea Tringali

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

,

Federico Barbaro

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

,

Margherita Pizzicannella

²Surgical Department, Campus Bio Medico University Hospital, Rome, Italy

,

Ivo Boškoski

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

,

Pietro Familiari

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

,

Vincenzo Perri

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

,

Giovanni Gigante

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

,

Graziano Onder

³Department of Geriatrics, Catholic University, Gemelli University Hospital, Rome, Italy

,

Cesare Hassan

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

,

Raffaella Lionetti

⁴Hepatology Unit, National Institute for Infectious Diseases, L. Spallanzani Hospital, Rome, Italy

,

Giuseppe Maria Ettorre

⁵General Surgery and Transplantation Unit, San Camillo Hospital, Rome, Italy

,

Guido Costamagna

¹Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Rome, Italy

⁶IHU, USIAS Strasbourg University, Strasbourg, France

› Author Affiliations

Abstract

Background and aims: Anastomotic biliary stricture (ABS) is the most common biliary complication after orthotopic liver transplantation (OLT) and can be successfully managed endoscopically. The long-term results of a protocol using placement of multiple plastic stents to treat ABS following OLT were analyzed.

Methods: All patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for OLT-related biliary complications at our Endoscopy Unit between July 1994 and March 2012 were retrospectively identified from the ERCP database. Patients with an ABS treated with an increasing number of plastic stents were included in the study. Follow-up after stent removal was obtained by telephone contact with the patient and/or referring physician and by liver function tests (LFTs) evaluation.

Results: 56 patients, treated with an increasing number of plastic stents until resolution of the stricture, were included. Five patients were then excluded (unrelated death during treatment, n = 3; incomplete treatment because of poor compliance, n = 2), and 51/56 patients reached study end points and were included in the analysis. Resolution of ABS was obtained in 50/51 patients; 1 patient required hepaticojejunostomy because of failure to pass the stricture with the guidewire (per protocol resolution, 98 %). Mean duration of endoscopic treatment was 11.5 months, with a median 4 ERCPs per patient. Immediate ERCP-related adverse events occurred in 3/56 patients (5.4 %). After a median follow-up of 5.8 years from stent removal, 3/50 patients (6 %) had recurrence of ABS. These 3 patients were successfully treated again endoscopically and are asymptomatic after a further median follow-up of 5.6 years.

Conclusions: At long-term follow-up, endoscopic treatment with multiple plastic stents of ABS following OLT appeared to be effective in most patients. Stricture recurrence is rare and can be successfully treated again endoscopically.

Full Text

References

References
1 Ayoub WS, Esquivel CO, Martin P. Biliary complications following liver transplantation. Dig Dis Sci 2010; 55: 1540-1546
2 Krok KL, Cardenas A, Thuluvath PJ. Endoscopic management of biliary complications after liver transplantation. Clin Liv Dis 2010; 14: 359-371
3 Seehofer D, Eurich D, Veltzke-Schlieker W et al. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant 2013; 13: 253-265
4 Scanga AE, Kowdley KV. Management of biliary complications following orthotopic liver transplantation. Curr Gastroenterol Rep 2007; 9: 31-38
5 Paik WH, Lee SH, Ryu JK et al. Long term outcome of biliary cast syndrome in liver complications in orthotopic liver transplantation recipients. Liver Transpl 2013; 19: 275-282
6 Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl 2008; 14: 756-769
7 Costamagna G, Pandolfi M, Mutignani M et al. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc 2001; 54: 162-168
8 Nuzzo G, Giuliante F, Giovannini I et al. Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy. Am J Surg 2008; 195: 763-769
9 Devière J, Reddy ND, Püspök A et al. Benign Biliary Stenoses Working Group. Successful management of benign biliary strictures with fully covered self-expanding metal stents. Gastroenterology 2014; 147: 385-395
10 Alazmi WM, Fogel EL, Watkins JL et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy 2006; 38: 571-574
11 Zoepf T, Maldonado-Lopez EJ, Hilgard P et al. Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation. Liver Transpl 2006; 12: 88-94
12 Rerknimitr R, Sherman S, Fogel EL et al. Biliary tract complications after orthotopic liver transplantation with choledocho-choledochostomy anastomosis: endoscopic findings and results of therapy. Gastrointest Endosc 2002; 55: 224-231
13 Morelli J, Mulcahy HE, Willner IR et al. Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointest Endosc 2003; 58: 374-379
14 Verdonk RC, Buis CI, Porte RJ et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. causes and consequences. Liver Transpl 2006; 12: 726-735
15 Graziadei IW, Schwaighofer H, Koch R et al. Long-term outcome endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl 2006; 12: 718-725
16 Holt AP, Thorburn D, Mirza D et al. A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation 2007; 84: 857-863
17 Pasha SF, Harrison ME, Das A et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc 2007; 66: 44-51
18 Morelli G, Fazel A, Judah J et al. Rapid sequence endoscopic management of post transplant anastomotic biliary strictures. Gastrointest Endosc 2008; 67: 879-885
19 Tabibian JH, Asham EH, Han S et al. Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video). Gastrointest Endosc 2010; 71: 505-512
20 Poley JW, Lekkerkerker MN, Metselaar HJ et al. Clinical outcome of progressive stenting in patients with anastomotic strictures after orthotopic liver transplantation. Endoscopy 2013; 45: 567-570
21 Luman W, Cull A, Palmer KR. Quality of life in patients stented for malignant biliary obstructions. Eur J Gastroenterol Hepatol 1997; 9: 481-484
22 Hsieh TH, Mekeel KL, Crowell MD et al. Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc 2013; 77: 47-54
23 Kahaleh M, Behm B, Clarke BW et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video). Gastrointest Endosc 2008; 67: 446-454
24 Mahajan A, Ho H, Sauer B et al. Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video). Gastrointest Endosc 2009; 70: 303-309
25 Chaput U, Scatton O, Bichard B et al. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc 2010; 72: 1167-1174
26 Tarantino I, Traina M, Mocciaro F et al. Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation. Endoscopy 2012; 44: 246-250
27 Tee HP, James MW, Kaffes AJ. Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture. World J Gastroenterol 2010; 16: 3597-3600
28 Tringali A, Blero D, Boškoski I et al. Difficult removal of fully covered self expandable metal stents (SEMS) for benign biliary strictures: the “SEMS in SEMS” technique. Dig Liver Dis 2014; 46: 568-571
29 Dumonceau JM, Tringali A, Blero D et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44: 277-298