Management of biliary anastomotic strictures (AS) after liver transplantation remains to be defined. To retrospectively report the endotherapy workload for duct-to-duct AS and its management in Italy. A questionnaire was sent to the Endoscopy Units of Italian Liver Transplantation Centers. Nineteen of the total 21 Units (90%) returned the questionnaire, twelve being high-volume (>250 ERCPs/year) units. During 2013, 248 liver-transplanted (LT) patients underwent AS endotherapy and 560 (7.3%) out of 7,679 ERCPs (median/center 16, range 5‒204) were performed for AS. After unsuccessful ERCP, interventional radiology or surgery was used in 6.0 % and 3.2 % of patients, respectively. The ERCP selection criteria included the trend of liver tests in 84% of the units, associated with AS as documented by non-invasive imaging in 90%. AS was treated by fully covered self expandable metal stent (SEMS) or plastic multistenting (PM) in eight centers, only by PM in ten and by single plastic stenting in one. SEMS was used independently of the overall ERCP workload and removed after three (37%) or six (63%) months. PM was planned at three-month intervals or at stent dysfunction in 94% of the units. The duration of endotherapy was planned up to the radiological resolution of the stricture in most centers. Recurrent AS was treated endoscopically in 79% of centers, by PM in most units and by fully covered SEMS in 5%. In Italy endotherapy is confirmed as the preferred first and second-line management option for AS and progressive plastic multi-stenting is most frequently used.
Management of Biliary Anastomotic Strictures After Liver Transplantation (BASALT Study): a Nationwide Italian Survey.
FILIPPONI, FRANCO;
2017-01-01
Abstract
Management of biliary anastomotic strictures (AS) after liver transplantation remains to be defined. To retrospectively report the endotherapy workload for duct-to-duct AS and its management in Italy. A questionnaire was sent to the Endoscopy Units of Italian Liver Transplantation Centers. Nineteen of the total 21 Units (90%) returned the questionnaire, twelve being high-volume (>250 ERCPs/year) units. During 2013, 248 liver-transplanted (LT) patients underwent AS endotherapy and 560 (7.3%) out of 7,679 ERCPs (median/center 16, range 5‒204) were performed for AS. After unsuccessful ERCP, interventional radiology or surgery was used in 6.0 % and 3.2 % of patients, respectively. The ERCP selection criteria included the trend of liver tests in 84% of the units, associated with AS as documented by non-invasive imaging in 90%. AS was treated by fully covered self expandable metal stent (SEMS) or plastic multistenting (PM) in eight centers, only by PM in ten and by single plastic stenting in one. SEMS was used independently of the overall ERCP workload and removed after three (37%) or six (63%) months. PM was planned at three-month intervals or at stent dysfunction in 94% of the units. The duration of endotherapy was planned up to the radiological resolution of the stricture in most centers. Recurrent AS was treated endoscopically in 79% of centers, by PM in most units and by fully covered SEMS in 5%. In Italy endotherapy is confirmed as the preferred first and second-line management option for AS and progressive plastic multi-stenting is most frequently used.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
