Endoscopic retrograde cholangiography with biliary stent placement across biliary anastomotic strictures of orthotopic liver transplantation(OLT) patients

Background: Biliary complications after OLT is associated with significant morbidity and mortality. Biliary anastomotic strictures are traditionally treated operatively. We report our experience with the placement of biliary stents across the anastomotic stricture sites at the time of diagnostic endoscopic retrograde cholangiography(ERC). Methods: A retrospective review was performed of medical records of all patients referred for ERC from July 1994 to July 1996. Results: Of 768 ERCs performed, 92(12%) where OLT patients. 90(98%) of these OLT patients underwent primary duct-to-duct anastomosis over a T-tube. Three months after transplantation, T-tubes were routinely removed. Of the ninety patients undergoing ERC 18(20%) developed an anastomotic stricture associated with either clinical, histological or biochemical evidence of obstruction. The median onset of stricture was 4.8 months(range 3- 19). All patients underwent ERCP with placement of 10Fr biliary stents without sphincterotomies. Stents were replaced prophylactically every three months for six months unless complications or lack of biochemical or histologic improvement was noted. At the completion of this six month period stents were removed and patients assessed periodically for recurrence which was treated surgically. Median follow-up was 6.2months (range 1-14). Total Outcome ERCP/STENT 18 12 SURGERY 6 Complications: One patient developed severe pancreatitis require a prolonged hospitalization. This was followed by eventual surgical intervention to correct obstructive process. No episodes of cholangitis, bleeding or perforation were noted. Conclusions: Biliary anastomotic strictures after liver transplantation can be effectively managed with biliary stents in a subset of patients with low morbidity. Endoscopically treated anastomotic strictures may delay eventual surgical intervention by several weeks to months allowing patients to recover during peri-transplant period.