LONG-TERM EFFICACY OF ENDOSCOPIC STENTING IN PATIENTS WITH STRICTURE OF THE BILIARY ANASTOMOSIS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Background and Study Aims: The choledocho-choledochostomy (CCS) strict ure is one of the most frequent complications occurring after liver tr ansplantation. Endoscopic retrograde cholangiography (ERCP) is the mos t sensitive method used to define the presence and narrowness of the s tricture. Endoscopic stenting of the strictured anastomosis could prov ide an effective alternative to the surgical intervention. Patients an d Method: ERCP was performed in 36 of 210 patients with liver transpla ntation and acute cholestasis or jaundice: in 15 cases biliary anastom otic stricture was found. These patients were endoscopically treated b y long-term stenting of the common bile duct (CBD) (1 year) and follow ed up for more than 12 months after stent removal. Results: In all cas es the stenting procedure resolved the biliary obstruction syndrome wi thin 7 days. At the end of the stenting period the CCS was dilated eno ugh to allow adequate bile flow and absence of cholestasis, Moreover, in most patients (10) the anastomosis was kept patent for more than 1 year after stent removal, whereas only two patients had stricture recu rrence and needed endoscopic restenting. Four patients dropped out of the study, respectively because of liver rejection (two), acute liver failure (one) and myocardial infarction (one). One patient who develop ed a stone of the transplanted CBD underwent surgical intervention. Co nclusions: According to our data, the endoscopic stenting of the CBD m ight be considered as the first choice procedure in the setting of the biliary anastomotic strictures occurring after liver transplantation. It has proved to be safe and effective, avoiding the need for more in vasive surgery, which in any case should be considered for nonresponsi ve patients.