This clinical practice guideline from the American Society for Gastrointestinal Endoscopy
provides an evidence-based approach for strategies to manage biliary strictures in
liver transplant recipients. This document was developed using the Grading of Recommendations
Assessment, Development and Evaluation framework. The guideline addresses the role
of ERCP versus percutaneous transhepatic biliary drainage and covered self-expandable
metal stents (cSEMSs) versus multiple plastic stents for therapy of strictures, use
of MRCP for diagnosing post-transplant biliary strictures, and administration of antibiotics
versus no antibiotics during ERCP. In patients with post-transplant biliary strictures,
we suggest ERCP as the initial intervention and cSEMSs as the preferred stent. In
patients with unclear diagnosis or intermediate probability of a stricture, we suggest
MRCP as the diagnostic modality. We suggest that antibiotics should be administered
during ERCP when biliary drainage cannot be assured.
Abbreviations:
AE (adverse event), ASGE (American Society for Gastrointestinal Endoscopy), CI (confidence interval), CPT (Current Procedural Terminology), cSEMS (covered self-expandable metal stent), GRADE (Grading of Recommendations Assessment, Development and Evaluation), MPS (multiple plastic stent), PICO (patient/population, intervention, comparison, and outcomes), PTBD (percutaneous transhepatic biliary drainage), RCT (randomized controlled trial)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Patients with post-transplant biliary strictures have significantly higher rates of liver transplant failure and rejection: a nationwide inpatient analysis.J Gastroenterol Hepatol. 2021; 36: 2008-2014
- Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.CMAJ. 2014; 186: E123-E142
- GRADE guidelines: 15. Going from evidence to recommendation—determinants of a recommendation's direction and strength.J Clin Epidemiol. 2013; 66: 726-735
- American Society for Gastrointestinal Endoscopy guideline on management of post–liver transplant biliary strictures: summary and recommendations.Gastrointest Endosc. 2023; 97: 607-614
- ASGE guideline on screening and surveillance of Barrett's esophagus.Gastrointest Endosc. 2019; 90: 335-359
- ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction.Gastrointest Endosc. 2021; 93: 309-322
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924-926
- Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiodrainage in biliary strictures after liver transplantation: long-term outcome predictors and influence on patient survival.Liver Int. 2019; 39: 1155-1164
- Optimal interventional treatment and long-term outcomes for biliary stricture after liver transplantation.Clin Transplant. 2008; 22: 484-493
- Percutaneous interventional management of biliary complications after pediatric liver transplantation: a 16-year single-institution experience.Pediatr Transplant. 2017; 21
- Quality assessment for systematic reviews and meta-analyses of cohort studies.Gastrointest Endosc. 2021; 93: 486-494
- Endoscopic approach for management of biliary strictures in liver transplant recipients: a systematic review and meta-analysis.United Eur Gastroenterol J. 2017; 5: 827-845
- Liver transplant-related anastomotic biliary strictures: a novel, rapid, safe, radiation-sparing, and cost-effective management approach.Gastrointest Endosc. 2018; 87: 501-508
- Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial.JAMA. 2016; 315: 1250-1257
- Self-expandable metallic stent is more cost efficient than plastic stent in treating anastomotic biliary stricture.Dig Dis Sci. 2020; 65: 600-608
- A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation.Therap Adv Gastroenterol. 2014; 7: 64-71
- Managing the post-liver transplantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review.Gastrointest Endosc. 2013; 77: 679-691
- Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents: a meta-analysis.Endoscopy. 2017; 49: 682-694
- Endoscopic treatment of anastomotic biliary stricture after adult deceased donor liver transplantation with multiple plastic stents versus self-expandable metal stents: a systematic review and meta-analysis.Transplant Int. 2018; 31: 131-151
- Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial.Gastrointest Endosc. 2018; 87: 131
- Management of liver transplantation biliary stricture: results from a tertiary hospital.World J Gastrointest Endosc. 2015; 7: 747-757
- Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: a prospective, randomized, multicenter trial.Gastrointest Endosc. 2017; 86: 1038-1045
- Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: a meta-analysis of randomized controlled trials.Ann Gastroenterol. 2019; 32: 407
- Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials.Endosc Int Open. 2018; 6: E914-E923
- Management of anastomotic biliary stricture after liver transplantation: metal versus plastic stent.Ann Gastroenterol. 2018; 31: 728
- Cost-effectiveness interim analysis of a randomized controlled trial comparing fully covered self expandable metal stenting and plastic multistenting for biliary anastomotic stricture after liver transplantation.Dig Liver Dis. 2018; 50: E107
- A new fully covered self-expandable metal stent for the treatment of postsurgical benign biliary strictures.Dig Dis Sci. 2017; 62: 2550-2557
- Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions.Endosc Int Open. 2021; 9: E888-E894
- Role of MRCP in diagnosing biliary anastomotic strictures after liver transplantation: a single tertiary care center experience.Transplant Direct. 2018; 4: e347
- Accuracy of magnetic resonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation.Transplant Proc. 2005; 37: 3924-3925
- Ischemic-type biliary lesions after ortothopic liver transplantation: diagnosis with magnetic resonance cholangiography.Transplant Proc. 2011; 43: 2660-2663
- Detection of biliary stenoses in patients after liver transplantation: Is there a different diagnostic accuracy of MRCP depending on the type of biliary anastomosis?.Eur J Radiol. 2011; 80: E20-E28
- Diagnostic accuracy of laboratory tests and diagnostic imaging in detecting biliary strictures after liver transplantation.Dig Dis Sci. 2017; 62: 1327-1333
- MR cholangiography of late biliary complications after liver transplantation.AJR Am J Roentgenol. 1999; 172: 1541-1546
- Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation.Acta Cirg Brasil. 2010; 25: 249-256
- Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation.Radiol Med. 2010; 115: 1065-1079
- Role of magnetic resonance imaging in the detection of anastomotic biliary strictures after liver transplantation.Transplant Proc. 2011; 43: 1132-1135
- Biliary complications after liver transplantation: diagnosis with MR cholangiopancreatography.AJR Am J Roentgenol. 2005; 184: 812-820
- Bile duct strictures after hepatobiliary surgery: assessment with MR cholangiography.Radiology. 2004; 231: 101-108
- Diagnostic and follow up value of magnetic resonance cholangiography in biliary complications after orthotopic liver transplantation [in Chinese].Zhong Yi Xue Za Zhi. 2007; 87: 3276-3279
- Orthotopic liver transplantation: evaluation with MR cholangiography.Radiology. 1999; 211: 715-722
- Detection of biliary complications after orthotopic liver transplantation with MR cholangiography.Magn Reson Imaging. 2001; 19: 1097-1105
- MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complications.Clin Transplant. 2010; 24: E82-E87
- Impact of magnetic resonance cholangiography in managing liver-transplanted patients: preliminary results of a clinical decision-making study.Radiol Med. 2011; 116: 1250-1266
- Evaluation of biliary complications on magnetic resonance cholangiopancreatography and comparison with direct cholangiography after living-donor liver transplantation.Clin Radiol. 2017; 72: 518-521
- Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography—long-term follow-up.Clin Transplant. 2010; 24: E163-E169
- Comparison of different MRCP techniques for the depiction of biliary complications after liver transplantation.Eur Radiol. 2010; 20: 1749-1756
- Value of MR cholangiography in the evaluation of postoperative biliary complications following orthotopic liver transplantation.Eur Radiol. 2000; 10: 1576-1581
- Magnetic resonance cholangiography of biliary strictures after liver transplantation: a prospective double-blind study.J Magn Reson Imaging. 2007; 25: 1168-1173
- Antibiotic prophylaxis for GI endoscopy.Gastrointest Endosc. 2015; 81: 81-89
- ASGE guideline on the management of cholangitis.Gastrointest Endosc. 2021; 94: 207-221
- Infectious complications following endoscopic retrograde cholangiopancreatography: an automated surveillance system for detecting postprocedure bacteremia.Am J Infect Control. 2008; 36: 592-594
- Bacteremia following diagnostic and therapeutic ERCP.Gastrointest Endosc. 1992; 38: 444-449
- Infection after ERCP, and antibiotic prophylaxis: a sequential quality-improvement approach over 11 years.Gastrointest Endosc. 2008; 67: 471-475
- Significant infections in liver transplant recipients undergoing endoscopic retrograde cholangiography are few and unaffected by prophylactic antibiotics.Dig Liver Dis. 2018; 50: 1220-1224
- FDA adds "black box" warning label to fluoroquinolone antibiotics.BMJ. 2008; 337: a816
- Interactions between tacrolimus and antimicrobial agents.Clin Infect Dis. 1997; 25: 1430-1440
Article info
Publication history
Published online: February 13, 2023
Accepted:
October 4,
2022
Received:
September 28,
2022
Footnotes
This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
