Background and Aims
Biliary strictures after liver transplantation are associated with significant morbidity
and mortality. Although various endoscopic treatment strategies are available, consensus
on a particular strategy is lacking. Moreover, the influence of endoscopic therapy
on overall survival has not been studied. This retrospective study aimed to evaluate
the impact of scheduled endoscopic dilatation of biliary strictures after orthotopic
liver transplantation on therapeutic success, adverse events, and survival.
Methods
Between 2000 and 2016, patients with post-transplant anastomotic and nonanastomotic
strictures were treated with balloon dilatation at defined intervals until morphologic
resolution and clinical improvement. The primary clinical endpoint was overall survival,
whereas secondary outcomes were technical and sustained clinical success, adverse
events, treatment failure, and recurrence.
Results
Overall, 165 patients with a mean follow-up of 8 years were included; anastomotic
and nonanastomotic strictures were diagnosed in 110 and 55 patients, respectively.
Overall survival was significantly higher in patients with anastomotic strictures
than in those with nonanastomotic strictures (median, 17.6 vs 13.9 years; log-rank:
P < .05). Sustained clinical success could be achieved significantly more frequently
in patients with anastomotic strictures (79.1% vs 54.5%, P < .001), and such patients showed significantly superior overall survival (19.7 vs
7.7 years; log-rank: P < .001). Sustained clinical success and the presence of nonanastomotic strictures
were independently associated with better and worse outcomes (P < .05), respectively.
Conclusions
Scheduled endoscopic treatment of biliary anastomotic and nonanastomotic strictures
after liver transplantation is effective and safe, with high success rates. The implementation
of this strategy controls symptoms and significantly improves survival.
Graphical abstract
Graphical Abstract
Abbreviation:
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Article info
Publication history
Published online: August 27, 2022
Accepted:
August 20,
2022
Received:
July 4,
2022
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
