Optimal interventional treatment and long-term outcomes for biliary stricture after liver transplantation

Abstract:  We undertook an evaluation of the clinical outcomes of endoscopic cholangioplasty (ECP) and percutaneous cholangioplasty (PCP) for biliary strictures after liver transplantation. We compared success rates of intervention, patency after successful intervention and procedure-related morbidities in 79 patients with anastomotic stricture (n = 54) or non-anastomotic stricture (n = 25). Twenty-five ECP and 61 PCP procedures were performed; seven PCP procedures were consecutively performed after failure of ECP. Fifty-one (64.6%) patients were successfully treated by cholangioplasty. Successful intervention rates (60.0% in ECP vs. 59.3% in PCP, p = 1.00) and patencies after successful intervention (44.8 ± 7.4 months in ECP vs. 41.9 ± 3.4 months in PCP, p = 0.47) were no different for the two techniques. However, the number of intervention sessions for PCP (7.2 ± 0.6) was higher than for ECP (2.9 ± 0.6) (p < 0.01). Multivariate analysis showed that only an anastomotic stricture was found to be related with a longer patency with an estimated odds ratio of 5.74 (p = 0.04) and had a tendency to be associated with successful intervention with an estimated odds ratio of 3.12 (p = 0.07) irrespective of techniques. Endoscopic access should be the preferred first approach in patients with biliary stricture after liver transplantation irrespective of the type of stricture, in view of its less invasive nature and patient convenience.