Endoscopic treatment in biliary strictures after pediatric liver transplantation

Pediatr Transplant. 2018 Nov;22(7):e13271. doi: 10.1111/petr.13271. Epub 2018 Jul 24.

Abstract

Background and aim: The aim of the study was to assess efficacy and safety of endoscopic treatment in BS after pediatric LTx.

Methods: We retrospectively reviewed data of patients with DDA who developed BS and underwent ERCP.

Results: Of 189 transplanted patients with DDA, strictures developed in 30 (16%). In this subgroup, the median age at LTx was 14.7 (1.5-17.6) and follow-up period was 3.9 (1.3-11.3). ABS were in 76% and NABS in combination with ABS in 24% of patients. Overall, 95 ERCP sessions (3.0 per patient) were performed with successful outcome in 22 (73%) cases. Duration of treatment was 9.1 (1.8-24.1) months. Five patients underwent surgical revision and three patients retransplantation (10%). Risk factors of endoscopy failure were HCV or HBV infection, prolonged CIT and treatment before 2007. The most common complications after ERCP were cholangitis (8.2%) and pancreatitis (4.2%). There were worse overall prognosis and higher risk of post-ERCP complications in NABS.

Conclusions: ERCP is safe and effective in the majority of patients with post-transplant duct-to-duct BS, and it is currently recommended as the first-line treatment.

Keywords: anastomotic stricture; biliary complications; cholangitis; pancreatitis.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cholangiopancreatography, Endoscopic Retrograde*
  • Cholestasis / etiology
  • Cholestasis / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Liver Transplantation*
  • Male
  • Postoperative Complications / therapy*
  • Retrospective Studies
  • Treatment Outcome