摘要
AIM: To review results of endoscopic treatment for anastomotic biliary strictures after orthotopic liver transplantation(OLT) during an 8-year period. METHODS: This is a retrospective review of all endoscopic retrograde cholangiopancreatographys(ERCPs) performed between May 2006 and June 2014 in deceased OLT recipients with anastomotic stricture at a tertiary care hospital. Patients were divided into 2 groups, according to the type of stent used(multiple plastic or covered self-expandable metal stents), which was chose on a case-by-case basis and their characteristics. The primary outcome was anastomotic stricture resolution rate determined if there was no more than a minimum waist at cholangiography and a 10 mm balloon could easily pass through the anastomosis with no need for further intervention after final stent removal. Secondary outcomes were technical successrate, number or ERCPs required per patient, number of stents placed, stent indwelling, stricture recurrence rate and therapy for recurrent anastomotic biliary stricture(AS). Stricture recurrence was defined as clinical laboratorial and/or imaging evidence of obstruction at the anastomosis level, after it was considered completely treated, requiring subsequent interventional procedure.RESULTS: A total of 195 post-OLT patients were assessed for eligibility. One hundred and sixty-four(164) patients were diagnosed with anastomotic biliary stricture. ERCP was successfully performed in 157/164(95.7%) patients with AS, that were treated with either multiple plastic(n = 109) or metallic billiary stents(n = 48). Mean treatment duration, number of procedures and stents required were lower in the metal stent group. Acute pancreatitis was the most common procedure related complication, occurring in 17.1% in the covered self-expandable metal stents(c SEMS) and 4.1% in the multiple plastic stent(MPS) group. Migration was the most frequent stent related complication, observed in 4.3% and 5.5%(c SEMS and MPS respectively). Stricture resolution was achieved in 86.8% in the c SEMS group and in 91% in MPS group. Stricture recurrence after a median follow up of 20 mo was observed in 10(30.3%) patients in the c SEMS and 7(7.7%) in the plastic stent group, a statistically significant difference(P = 0.0017). Successful stricture resolution after secondary treatment was achieved in 66.6% and 62.5% of patients respectively in the c SEMS and plastic stents groups. CONCLUSION: Multiple plastic stents are currently the first treatment option for AS in patients with duct-toduct anastomosis. c SEMS was associated with increased pancreatitis risk and higher recurrence rate.
AIM： To review results of endoscopic treatment foranastomotic biliary strictures after orthotopic livertransplantation （OLT） during an 8-year period.METHODS： This is a retrospective review of all endoscopicretrograde cholangiopancreatographys （ERCPs）performed between May 2006 and June 2014 indeceased OLT recipients with anastomotic stricture ata tertiary care hospital. Patients were divided into 2groups, according to the type of stent used （multipleplastic or covered self-expandable metal stents）, whichwas chose on a case-by-case basis and their characteristics.The primary outcome was anastomotic strictureresolution rate determined if there was no more thana minimum waist at cholangiography and a 10 mmballoon could easily pass through the anastomosiswith no need for further intervention after final stentremoval. Secondary outcomes were technical successrate, number or ERCPs required per patient, number ofstents placed, stent indwelling, stricture recurrence rateand therapy for recurrent anastomotic biliary stricture（AS）. Stricture recurrence was defined as clinical laboratorialand/or imaging evidence of obstruction at theanastomosis level, after it was considered completelytreated, requiring subsequent interventional procedure.RESULTS： A total of 195 post-OLT patients wereassessed for eligibility. One hundred and sixty-four（164） patients were diagnosed with anastomotic biliarystricture. ERCP was successfully performed in 157/164（95.7%） patients with AS, that were treated with eithermultiple plastic （n = 109） or metallic billiary stents （n =48）. Mean treatment duration, number of proceduresand stents required were lower in the metal stent group.Acute pancreatitis was the most common procedurerelated complication, occurring in 17.1% in the coveredself-expandable metal stents （cSEMS） and 4.1% in themultiple plastic stent （MPS） group. Migration was themost frequent stent related complication, observed in4.3% and 5.5% （cSEMS and MPS respectively）. Strictureresolution was achieved in 86.8% in the cSEMS groupand in 91% in MPS group. Stricture recurrence after amedian follow up of 20 mo was observed in 10 （30.3%）patients in the cSEMS and 7 （7.7%） in the plastic stentgroup, a statistically significant difference （P = 0.0017）.Successful stricture resolution after secondary treatmentwas achieved in 66.6% and 62.5% of patients respectivelyin the cSEMS and plastic stents groups.CONCLUSION： Multiple plastic stents are currently thefirst treatment option for AS in patients with duct-toductanastomosis. cSEMS was associated with increasedpancreatitis risk and higher recurrence rate.
基金
Supported by Boston Scientific,EMcison,Xlumena,Mauna Kea Tech,MI Tech,Apollo Endosurgery,Cook Endoscopy,W.L.Gore Associates,GI Dynamics and ASPIRE Bariatrics(Kahaleh M)
