Liver transplant–related anastomotic biliary strictures: a novel, rapid, safe, radiation-sparing, and cost-effective management approach

Autor: Subhas Banerjee, Robert J. Huang, Abhishek Choudhary, Monique T. Barakat, Mohit Girotra, Nirav Thosani
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Time Factors
Orthotopic liver transplantation
medicine.medical_treatment
Operative Time
Population
Constriction
Pathologic
Anastomosis
Article
Prosthesis Implantation
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Fluoroscopy
Radiology
Nuclear Medicine and imaging
030212 general & internal medicine
education
Adverse effect
Aged
Cholangiopancreatography
Endoscopic Retrograde
education.field_of_study
Cholestasis
medicine.diagnostic_test
business.industry
Anastomosis
Surgical
Gastroenterology
Stent
Effective management
Health Care Costs
Middle Aged
Radiation Exposure
Liver Transplantation
Surgery
Endoscopy
Treatment Outcome
surgical procedures
operative
Equipment and Supplies
Female
Stents
030211 gastroenterology & hepatology
Bile Ducts
Radiology
business
Zdroj: Gastrointestinal Endoscopy. 87:501-508
ISSN: 0016-5107
Popis: Biliary strictures after orthotopic liver transplantation (OLT) are typically managed by sequential ERCP procedures, with incremental dilation of the stricture and stent exchange (IDSE) and placement of new stents. This approach resolves80% of strictures after 12 months but requires costly, lengthy ERCPs with significant patient radiation exposure. Increasing awareness of the harmful effects of radiation, escalating healthcare costs, and decreasing reimbursement for procedures mandate maximal efficiency in performing ERCP. We compared the traditional IDSE protocol with a sequential stent addition (SSA) protocol, in which additional stents are placed across the stricture during sequential ERCPs, without stent removal/exchange or stricture dilation.Patients undergoing ERCP for OLT-related anastomotic strictures from 2010 to 2016 were identified from a prospectively maintained endoscopy database. Procedure duration, fluoroscopy time, stricture resolution rates, adverse events, materials fees, and facility fees were analyzed for IDSE and SSA procedures.Seventy-seven patients underwent 277 IDSE and 132 SSA procedures. Mean fluoroscopy time was 64.5% shorter (P .0001) and mean procedure duration 41.5% lower (P .0001) with SSA compared with IDSE. SSA procedures required fewer accessory devices, resulting in significantly lower material (63.8%, P .0001) and facility costs (42.8%, P .0001) compared with IDSE. Stricture resolution was95%, and low adverse event rates did not significantly differ.SSA results in shorter, cost-effective procedures requiring fewer accessory devices and exposing patients to less radiation. Stricture resolution rates are equivalent to IDSE, and adverse events do not differ significantly, even in this immunocompromised population.
Databáze: OpenAIRE
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