James Tabibian¹ , Emad Asham¹ , Leonard Goldstein¹ , Steven Han¹ , Sammy Saab¹ , Myron Tong¹ , Ronald Busuttil¹ , Francisco Durazo¹

¹ Dumont-UCLA Liver Transplant Center

Introduction : We investigated the effect of endoscopic retrograde cholangiopancreatography (ERCP) with maximal stenting on the outcome of post-orthotopic liver transplantation (OLT) anastomotic biliary strictures (AS). 

Methods : Fifty-nine patients with post-OLT AS underwent ERCP with dilation and insertion of a maximal number of stents. Stents were not changed until signs or symptoms of obstruction were noted. Outcomes were AS resolution or hepaticojejunostomy (HJ).  Four variables were evaluated: total number of stents, mean number of stents per ERCP, number of ERCPs, and time from OLT to AS diagnosis. Data were analyzed with t-tests.

Results : Median time from OLT to AS was 7 months. Median number of ERCPs was 3 (range 1-7). Fifty-five patients (93%) achieved resolution and 4 (7%) required HJ. Comparing the resolution and HJ groups, there were 8.3 (±5.4) (mean ±SD) vs 3.5 (±2.4) total stents (p<0.016), 2.5 (±1.2) vs 1.3 (±0. 47) stents per ERCP (p=0.006), 3.3 (±1.6) vs 2.5 (±1.3) ERCPs (p=0.33), and 14 (±19) vs. 22 (±42) months from OLT to AS diagnosis (p=0.75). One case of ERCP pancreatitis and none of cholangitis due to stent occlusion occurred out of 246 total ERCPs. In a median follow-up of 25 months, 2 patients had AS recurrence that was successfully re-treated with ERCP.

Conclusion : AS resolution is directly related to number of stents used in total and per ERCP. Maximal stenting for AS is effective, safe, seldom associated with AS recurrence, and conducive to less frequent ERCPs for stent exchange compared to conventional treatment.

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