Earlier Index Endoscopic Retrograde Cholangiopancreatography Is Associated With Biliary Stricture Resolution After...

Biliary strictures are the most common biliary complication following orthotopic liver transplantation (OLT). While factors associated with stricture formation are relatively well-studied, variables related to their resolution remain poorly understood. The goal of this study was to identify factors associated with the resolution of post-OLT anastomotic biliary strictures.

We conducted a retrospective cohort study of patients who underwent OLT and developed an anastomotic biliary stricture in a single health system from 2019 to 2022. The primary outcome was defined as endoscopic evidence of biliary stricture resolution (BSR), leading to stent removal. Secondary outcomes included the time to first endoscopic retrograde cholangiopancreatography (ERCP), the number of ERCPs performed, the type of stent used during ERCP, and complications associated with ERCP.

Of the 357 patients that underwent OLT, 96 (26.9%) patients developed a biliary stricture. ERCP was performed on 84 patients, and 12 patients underwent percutaneous transhepatic biliary drainage due to anatomical variations. BSR was achieved in 71 (84.5%) patients who underwent ERCP. The median time to the index ERCP was 57 d in patients with BSR, compared to 230 d in patients with persistent strictures (P = 0.01).

In patients with anastomotic biliary strictures following OLT who underwent ERCP, shorter time to first ERCP was independently associated with BSR. Further investigation into the development of post-OLT biliary strictures, the ERCP technique, and the behavior of biliary strictures is needed to fully understand this relationship.