ERCP and short-term stent-trial in patients with anastomotic biliary stricture following liver transplantation
| Autor: | Laura Forzenigo, Maria Francesca Donato, Paolo Cantù, Giorgio Rossi, Roberto Penagini, L. Piodi, P. R. Biondetti, A. Tenca, F. Agnelli, Dario Conte, Cristina Rigamonti |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Cirrhosis medicine.medical_treatment Anastomosis Biliary Stenting Liver transplantation Young Adult Cholangiography medicine Humans Aged Cholangiopancreatography Endoscopic Retrograde Cholestasis Hepatology medicine.diagnostic_test business.industry Anastomosis Surgical Gastroenterology Stent Hepatitis C Chronic Middle Aged medicine.disease Liver Transplantation Surgery Transplantation Female Stents Radiology Liver function tests business Follow-Up Studies |
| Zdroj: | Digestive and Liver Disease. 41:516-522 |
| ISSN: | 1590-8658 |
| DOI: | 10.1016/j.dld.2008.08.002 |
| Popis: | Background Anastomotic biliary stricture represents one of the possible factors leading to liver dysfunction after transplantation. Purpose Our aims were to evaluate the role of endoscopic retrograde cholangio-pancreatography and a short-term stenting (stent-trial) in assessment of the clinical relevance of the biliary stricture. Materials and methods Thirty transplanted patients for HCV (n = 17) or non-HCV (n = 13)-related cirrhosis (27 M, median age 53 yr, range 24–67 yr) who developed persistently abnormal liver function tests and presented with an anastomotic biliary stricture suggested by non-invasive cholangiography, underwent endoscopic retrograde cholangio-pancreatography. If the stricture was confirmed, dilation was performed and a plastic stent was placed. Clinical and biochemical evaluation was done one and two months later. Resolution of symptoms and normalization or > 50% reduction of at least one liver function test were needed to consider the stricture as clinically relevant. Patients were followed up for a median of 19 months. Results Endoscopic retrograde cholangio-pancreatography was successful in 29 patients and confirmed the anastomotic biliary stricture in 19 (66%); 14 patients underwent endoscopic dilation and stenting and five patients underwent surgery. The stent-trial suggested the stricture to be clinically relevant in 7 of 14 patients, confirmed by prolonged stenting and follow-up. A trend towards a higher likelihood of a clinically relevant stricture was observed in HCV-negative compared to HCV-positive patients (5 of 7, 71% vs 2 of 7, 29% , respectively; p = 0.1). Conclusions Our data suggest that endoscopic retrograde cholangio-pancreatography is a valuable tool to evaluate the clinical relevance of an anastomotic stricture, when coupled with a short-term stent-trial. |
| Databáze: | OpenAIRE |
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