Endoscopic Management Of Plastic Stents Of Post-Liver Transplantation Anastomotic Biliary Stricture

OBJECTIVE:To evaluate the therapeutic effect of endoscopic management of plastic stents of post-liver transplantation anastomotic biliary stricture.METHODS:Between January 2010 and October 2015, the data of patients with post-liver transplantation ABSs and received endoscopic retrograde cholangiopancreatography and plastic stents management was collected. The technical success rate, ERCP-related complications, clinical remission rate and long-term complications were main outcome measurements to compare the efficacy and safety of different number of stents in managing post-liver transplantation anastomotic biliary stricture.RESULTS:Among the 18 patients (0.5-60.0 months) with post-liver transplantation ABSs, seven patients received less plastic stents treatment (<3 stents), nine patients with persistent anastomotic or recurrent stricture received multiple plastic stents treatment (≥3 stents), two patients received multiple plastic stents treatment once suffered with post-liver transplantation ABSs. The endoscopic technical success rate was seventy-six over eighty (95.0%). Among the seven patients received less plastic stents treatment, one loss to follow-up, two were still under treatment, one died of acute hepatic failure, one died of septic stock, one combined with biliary fistula resulted in treatment failure, one achieved clinical remission, the clinical remission rate was one third (33.3%). Among the eleven patients received multiple plastic stents treatment, two loss to follow-up, one was still under treatment, two received surgery because of failed treatment, six achieved clinical remission, the clinical remission rate was 75.0%(6/8). The average diameters of management of 1 stent,2 stents,3 stents, 4 stents,5 stents,7 stents were 8.5F,17.0F,24.0F,28.0F,36.0F,50.0F. Among the six early postoperative complications, five cases occurred in less stent management and one occurred in MPSs management, the early postoperative complication rate was 7.5%(6/80). No severe ERCP-related complications and procedure-related deaths.CONCLUSIONS:Endoscopic management of plastic stents is safe and effective for post-liver transplantation ABSs. Providing larger biliary support, the multiple plastic stents treatment was superior to less plastic stents treatment in view of clinical remission rate, especially for refractory one. Multiple plastic stents did not increase the incidence of complications, it could be used as the first-line treatment of post-liver transplantation duct-to-duct biliary anastomosis for its safety and effectivity.