Tags

Type your tag names separated by a space and hit enter

Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation.
Endoscopy. 2006 Jun; 38(6):571-4.E

Abstract

BACKGROUND AND STUDY AIMS

The development of anastomotic strictures is one of the most common complications of orthotopic liver transplantation (OLT) with choledochocholedochostomy anastomosis. Endoscopic therapy with balloon dilation and/or stent placement is an effective therapy. The aim of this study was to assess the recurrence rate of anastomotic strictures and the features that predict recurrence after previously successful endoscopic therapy.

PATIENTS AND METHODS

We searched the endoscopic retrograde cholangiopancreatography (ERCP) database for all patients who had had an OLT who were undergoing ERCP. The study cohort consisted of post-OLT patients who had a recurrence of anastomotic stricture after initial resolution following a course of endoscopic therapy.

RESULTS

A total of 916 OLT operations were performed during the study period from June 1994 to November 2004. Out of this group, 143 patients (15.6 %) were diagnosed with anastomotic stricture and underwent a total of 423 ERCPs for endoscopic treatment. Twelve patients who are still undergoing endoscopic therapy were excluded from the analysis. The technical success rate was 96.6 %, and the endoscopic therapy was successful in 82 % of patients; 18 % had a recurrence of cholestasis and ERCP revealed a recurrence of the anastomotic stricture that required intervention. The mean time of follow-up after stent removal was 28 months (range 1 - 114 months). The study did not reveal any clinical or endoscopic parameters that could predict recurrence, though the presence of a biliary leak at initial ERCP and a longer time to initial presentation were factors that showed a trend toward an increased likelihood of recurrence.

CONCLUSIONS

Biliary strictures remain a common complication after OLT, and in nearly one in five patients these strictures recur after initially successful endoscopic therapy. There were no clinical or endoscopic parameters identified in this study that predicted recurrence. Further study is needed to determine what type of endoscopic therapy would minimize the risk of stricture recurrence.

Authors+Show Affiliations

Indiana University Medical Center, Indianapolis, Indiana 46202, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16802268

Citation

Alazmi, W M., et al. "Recurrence Rate of Anastomotic Biliary Strictures in Patients Who Have Had Previous Successful Endoscopic Therapy for Anastomotic Narrowing After Orthotopic Liver Transplantation." Endoscopy, vol. 38, no. 6, 2006, pp. 571-4.
Alazmi WM, Fogel EL, Watkins JL, et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy. 2006;38(6):571-4.
Alazmi, W. M., Fogel, E. L., Watkins, J. L., McHenry, L., Tector, J. A., Fridell, J., Mosler, P., Sherman, S., & Lehman, G. A. (2006). Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy, 38(6), 571-4.
Alazmi WM, et al. Recurrence Rate of Anastomotic Biliary Strictures in Patients Who Have Had Previous Successful Endoscopic Therapy for Anastomotic Narrowing After Orthotopic Liver Transplantation. Endoscopy. 2006;38(6):571-4. PubMed PMID: 16802268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. AU - Alazmi,W M, AU - Fogel,E L, AU - Watkins,J L, AU - McHenry,L, AU - Tector,J A, AU - Fridell,J, AU - Mosler,P, AU - Sherman,S, AU - Lehman,G A, PY - 2006/6/28/pubmed PY - 2006/8/9/medline PY - 2006/6/28/entrez SP - 571 EP - 4 JF - Endoscopy JO - Endoscopy VL - 38 IS - 6 N2 - BACKGROUND AND STUDY AIMS: The development of anastomotic strictures is one of the most common complications of orthotopic liver transplantation (OLT) with choledochocholedochostomy anastomosis. Endoscopic therapy with balloon dilation and/or stent placement is an effective therapy. The aim of this study was to assess the recurrence rate of anastomotic strictures and the features that predict recurrence after previously successful endoscopic therapy. PATIENTS AND METHODS: We searched the endoscopic retrograde cholangiopancreatography (ERCP) database for all patients who had had an OLT who were undergoing ERCP. The study cohort consisted of post-OLT patients who had a recurrence of anastomotic stricture after initial resolution following a course of endoscopic therapy. RESULTS: A total of 916 OLT operations were performed during the study period from June 1994 to November 2004. Out of this group, 143 patients (15.6 %) were diagnosed with anastomotic stricture and underwent a total of 423 ERCPs for endoscopic treatment. Twelve patients who are still undergoing endoscopic therapy were excluded from the analysis. The technical success rate was 96.6 %, and the endoscopic therapy was successful in 82 % of patients; 18 % had a recurrence of cholestasis and ERCP revealed a recurrence of the anastomotic stricture that required intervention. The mean time of follow-up after stent removal was 28 months (range 1 - 114 months). The study did not reveal any clinical or endoscopic parameters that could predict recurrence, though the presence of a biliary leak at initial ERCP and a longer time to initial presentation were factors that showed a trend toward an increased likelihood of recurrence. CONCLUSIONS: Biliary strictures remain a common complication after OLT, and in nearly one in five patients these strictures recur after initially successful endoscopic therapy. There were no clinical or endoscopic parameters identified in this study that predicted recurrence. Further study is needed to determine what type of endoscopic therapy would minimize the risk of stricture recurrence. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/16802268/Recurrence_rate_of_anastomotic_biliary_strictures_in_patients_who_have_had_previous_successful_endoscopic_therapy_for_anastomotic_narrowing_after_orthotopic_liver_transplantation_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2006-925027 DB - PRIME DP - Unbound Medicine ER -