New endoscopic classification system for biliary stricture after liver transplantation

Area of Science:

• Gastroenterology
• Hepatology
• Transplant Surgery

Background:

• Biliary stricture (BS) is a common complication after liver transplantation (LT).
• Current classification systems lack standardization for endoscopic treatment.
• A need exists for a refined system to guide clinical decision-making.

Purpose of the Study:

• To introduce a novel endoscopic classification system for biliary stricture following liver transplantation.
• To standardize the approach to diagnosing and managing BS post-LT.

Main Methods:

• Retrospective analysis of endoscopic retrograde cholangiography images from 93 LT patients.
• Development of the Ling classification system based on image analysis.
• Classification by two independent endoscopists with consensus on disputed findings.

Main Results:

• The Ling classification includes four types (A, B, C, D) based on stricture location and characteristics.
• Type B (anastomotic stricture) was most frequent (47.3%).
• Types A, C, and D accounted for 9.7%, 23.7%, and 19.3% of cases, respectively.

Conclusions:

• The proposed Ling classification offers a standardized method for evaluating biliary strictures post-LT.
• This system aims to facilitate the selection of optimal endoscopic treatment strategies.
• Further validation is needed to confirm its clinical utility in diverse LT populations.