PMID- 23062758
OWN - NLM
STAT- MEDLINE
DCOM- 20130610
LR  - 20220330
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 77
IP  - 1
DP  - 2013 Jan
TI  - Endoscopic treatment of anastomotic biliary strictures after living donor liver 
      transplantation: outcomes after maximal stent therapy.
PG  - 47-54
LID - S0016-5107(12)02655-7 [pii]
LID - 10.1016/j.gie.2012.08.034 [doi]
AB  - BACKGROUND: Living-donor liver transplantation (LDLT) has emerged as a viable 
      strategy in an era of organ shortage. However, biliary strictures are a common 
      complication of LDLT, and these strictures frequently require surgical revision 
      after unsuccessful endoscopic therapy. The optimal endoscopic treatment for 
      anastomotic biliary strictures (ABSs) after LDLT is undefined. OBJECTIVE: To 
      determine the outcome of an aggressive endoscopic approach to ABSs after LDLT 
      that uses endoscopic dilation followed by maximal stent placement. DESIGN: A 
      retrospective study. SETTING: A tertiary-care academic medical center. PATIENTS: 
      Forty-one patients with a diagnosis of ABS. INTERVENTIONS: Endoscopic retrograde 
      cholangiography with balloon dilation and maximal stenting. MAIN OUTCOME 
      MEASUREMENTS: Stricture resolution, stricture recurrence, and complication rates. 
      RESULTS: Of 110 LDLTs completed, a biliary stricture developed after 
      transplantation in 41 (37.3%), which included 38 patients with duct-to-duct 
      anastomosis. The median (interquartile range [IQR]) follow-up time is 74.2 
      (2.5-120.8) months. Among them, 23 (60.5%) were male, and 20 (52.6%) had bile 
      leakage associated with ABSs. The median time (IQR) to the development of an ABS 
      after LDLT was 2.1 (1.2-4.1) months. Endoscopic retrograde cholangiography was 
      attempted as initial therapy in all patients: 32 were managed entirely by 
      endoscopic therapy, and 6 required initial percutaneous transhepatic 
      cholangiography (PTC) to cross the biliary stricture, with endoscopic therapy 
      performed thereafter. A median (IQR) of 4.0 (3.0-5.3) endoscopic interventions 
      and 7.0 (4.0-10.3) stents were required to resolve the stricture. The time from 
      the first intervention to stricture resolution was 5.3 (range 3.8-8.9) months. 
      Biochemical markers including aspartate transaminase (76 vs 39 U/L, P = .001), 
      alanine transaminase (127.5 vs 45.5 U/L, P < .001), alkaline phosphatase (590 vs 
      260 IU/L, P < .001), and total bilirubin (2.57 vs 1.73 mg/dL, P = .017) 
      significantly improved after intervention. Recurrent stricture was observed after 
      initial treatment in 8 (21%) patients. All recurrences were successfully 
      re-treated endoscopically. All patients have been managed without surgical 
      revision or retransplantation, resulting in 100% success by an intention-to-treat 
      analysis. LIMITATIONS: Retrospective study, small sample size. CONCLUSIONS: In 
      this series, aggressive endoscopy-based treatment with maximal stent placement 
      strategy allows 100% resolution of all duct-to-duct ABSs after LDLT without the 
      need for surgical intervention or retransplantation.
CI  - Copyright (c) 2013 American Society for Gastrointestinal Endoscopy. Published by 
      Mosby, Inc. All rights reserved.
FAU - Hsieh, Ting-Hui
AU  - Hsieh TH
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ 
      85259, USA.
FAU - Mekeel, Kristin L
AU  - Mekeel KL
FAU - Crowell, Michael D
AU  - Crowell MD
FAU - Nguyen, Cuong C
AU  - Nguyen CC
FAU - Das, Ananya
AU  - Das A
FAU - Aqel, Bashar A
AU  - Aqel BA
FAU - Carey, Elizabeth J
AU  - Carey EJ
FAU - Byrne, Thomas J
AU  - Byrne TJ
FAU - Vargas, Hugo E
AU  - Vargas HE
FAU - Douglas, David D
AU  - Douglas DD
FAU - Mulligan, David C
AU  - Mulligan DC
FAU - Harrison, M Edwyn
AU  - Harrison ME
LA  - eng
PT  - Journal Article
DEP - 20121011
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
RN  - EC 2.6.1.1 (Aspartate Aminotransferases)
RN  - EC 2.6.1.2 (Alanine Transaminase)
RN  - EC 3.1.3.1 (Alkaline Phosphatase)
RN  - RFM9X3LJ49 (Bilirubin)
SB  - IM
MH  - Alanine Transaminase/blood
MH  - Alkaline Phosphatase/blood
MH  - Aspartate Aminotransferases/blood
MH  - Biliary Tract Diseases/*surgery
MH  - Bilirubin/blood
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Cholestasis/surgery
MH  - Endoscopy, Digestive System/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - *Liver Transplantation
MH  - *Living Donors
MH  - Male
MH  - Postoperative Complications
MH  - Recurrence
MH  - Retrospective Studies
MH  - *Stents
MH  - Treatment Outcome
EDAT- 2012/10/16 06:00
MHDA- 2013/06/12 06:00
CRDT- 2012/10/16 06:00
PHST- 2012/02/23 00:00 [received]
PHST- 2012/08/30 00:00 [accepted]
PHST- 2012/10/16 06:00 [entrez]
PHST- 2012/10/16 06:00 [pubmed]
PHST- 2013/06/12 06:00 [medline]
AID - S0016-5107(12)02655-7 [pii]
AID - 10.1016/j.gie.2012.08.034 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2013 Jan;77(1):47-54. doi: 10.1016/j.gie.2012.08.034. Epub 
      2012 Oct 11.