Cholangiographic features and endoscopic treatment of biliary strictures

The most commonly occurring complications following orthotopic liver transplantation procedures are associated with the biliary tract. Endoscopic technique has become the primary modality for the treatment of biliary strictures after liver transplantation. The objective of this study was to assess the role of cholangiographic features of the initial cholangiogram in endoscopic treatment success and stricture recurrence.

Patients who underwent endoscopic therapy for biliary strictures after orthotopic liver transplantation (OLT), from 2006 to 2009 were included in this retrospective study.

The initial success rate after endoscopic treatment was achieved in 85.53% patients. However, recurrence of biliary strictures occurred in 24.62% of the patients. Patients with successful anastomotic biliary strictures (AS) after treatment were characterized by shorter stricture length as compared to patients who have not achieved success (p < 0.01). Of the 42 patients with AS, patients with recurrence had larger initial stricture length (p < 0.01) and smaller narrowing diameter (p < 0.01) than those without recurrence. Patients treated with NAS for multiple strictures experienced increased rate of recurrence than those with single narrowing, but failed to achieve statistical significance (50% vs. 23.08%, p = 0.18). Patients for whom dilation failed to eliminate the waist, experienced higher recurrence rate than those without stricture waist (70% vs. 16.63%, p < 0.01).

Endoscopic procedure using endoscopic retrograde cholangiopancreatography was found to be an effective modality for treating biliary strictures after OLT.