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 |
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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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