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 post-transplant
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 for extrahepatic strictures. In patients with unclear diagnoses 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 ensured.
Abbreviations:
AE (adverse event), ASGE (American Society for Gastrointestinal Endoscopy), CI (confidence interval), cSEMS (covered self-expandable metal stent), GRADE (Grading of Recommendations Assessment, Development and Evaluation), MPS (multiple plastic stent), OR (odds ratio), PTBD (percutaneous transhepatic biliary drainage), RCT (randomized controlled trial)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 14, 2023
Accepted:
October 4,
2022
Received:
September 28,
2022
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
