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The Efficacy and Safety of Endoscopic Balloon Dilation Combined with Stenting in Patients with Biliary Anastomotic Strictures After Orthotopic Liver Transplantation

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Abstract

Endoscopic balloon dilation combined with stenting has been increasingly used in managing biliary anastomotic strictures (BAS) after orthotopic liver transplantation (OLT). However, data on the efficacy and safety vary among different studies. To obtain reliable estimates for the efficacy and safety of this endoscopic combination therapy in post-OLT BAS. A systematic search was conducted in the literature published until June 2012. The outcomes of individual study were transformed into comparable data using the Freeman–Tukey double arcsine transformation method. Fixed-effect or random-effect models were built to simulate the outcomes. Subgroup analysis and meta-regression were used to explore the sources of clinical heterogeneity. Clinical resolution and recurrence were defined as the primary outcomes and complications and mortality as secondary outcomes. Nineteen studies (15 retrospective, 4 prospective; 17 full-texts, 2 abstracts) were included, with a total of 745 patients. Fully covered self-expandable metal stent was only reported in one study, achieving a resolution rate of 92.3 %, recurrence rate of 8.3 %, and complication rate of 7.7 %. For 18 studies using plastic stents, the pooled resolution rate was 86 % (95 % CI 80–91 %; I 2 = 74.7 %). Abstracts, study design, and the delay from OLT to BAS diagnosis were contributing factors for heterogeneity in resolution. The pooled recurrence rate was 9 % (95 % CI 5–13 %; I 2 = 59.6 %). Longer stenting duration predicted less recurrence (OR = 0.95, p = 0.002). The pooled complication rate was 14 % (95 % CI 8–21 %, I 2 = 71.2 %). No procedure-related mortality was reported. Endoscopic balloon dilation combined with stenting is a relatively effective and safe modality in post-OLT BAS.

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References

  1. Scatton, O., Meunier, B., Cherqui, D., et al. (2001). Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Annals of Surgery, 233(3), 432–437.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Hwang, S., Lee, S. G., Sung, K. B., et al. (2006). Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. Liver Transplantation, 12(5), 831–838.

    Article  PubMed  Google Scholar 

  3. Theilmann, L., Küppers, B., Kadmon, M., et al. (1994). Biliary tract strictures after orthotopic liver transplantation: Diagnosis and management. Endoscopy, 26(6), 517–522.

    Article  CAS  PubMed  Google Scholar 

  4. Mosca, S., Militerno, G., Guardascione, M. A., et al. (2000). Late biliary tract complications after orthotopic liver transplantation: Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography. Journal of Gastroenterology and Hepatology, 15(6), 654–660.

    Article  CAS  PubMed  Google Scholar 

  5. Thethy, S., Thomson, B. N. J., Pleass, H., et al. (2004). Management of biliary tract complications after orthotopic liver transplantation. Clinical Transplantion, 18(6), 647–653.

    Article  Google Scholar 

  6. Sharma, S., Gurakar, A., & Jabbour, N. (2008). Biliary strictures following liver transplantation: Past, present and preventive strategies. Liver Transplantation, 14(6), 759–769.

    Article  PubMed  Google Scholar 

  7. Rossi, A. F., Grosso, C., Zanasi, G., et al. (1998). Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation. Endoscopy, 30(4), 360–366.

    Article  CAS  PubMed  Google Scholar 

  8. Schwartz, D. A., Petersen, B. T., Poterucha, J. J., et al. (2000). Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation. Gastrointestinal Endoscopy, 51(2), 169–174.

    Article  CAS  PubMed  Google Scholar 

  9. Gómez, C. M., Dumonceau, J. M., Marcolongo, M., et al. (2009). Endoscopic management of biliary complications after adult living-donor versus deceased-donor liver transplantation. Transplantation, 88(11), 1280–1285.

    Article  PubMed  Google Scholar 

  10. Holt, A. P., Thorburn, D., Mirza, D., et al. (2007). A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation, 84(7), 857–863.

    Article  PubMed  Google Scholar 

  11. Alazmi, W. M., Fogel, E. L., Watkins, J. L., et al. (2006). Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy, 38(6), 571–574.

    Article  CAS  PubMed  Google Scholar 

  12. Zoepf, T., Maldonado-Lopez, E. J., Hilgard, P., et al. (2006). Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation. Liver Transplantation, 12(1), 88–94.

    Article  PubMed  Google Scholar 

  13. Tabibian, J. H., Asham, E. H., Han, S., et al. (2010). Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video). Gastrointestinal Endoscopy, 71(3), 505–512.

    Article  PubMed  Google Scholar 

  14. van Boeckel, P. G., Vleggaar, F. P., & Siersema, P. D. (2009). Plastic or metal stents for benign extrahepatic biliary strictures: A systematic review. BMC Gastroenterol., 17(9), 96.

    Article  Google Scholar 

  15. Morelli, J., Mulcahy, H. E., Willner, I. R., et al. (2003). Long-term outcomes for patients with post-liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointestinal Endoscopy, 58(3), 374–379.

    Article  PubMed  Google Scholar 

  16. Mahajan, A., Ho, H., Sauer, B., et al. (2009). Temporary placement of fully covered self-expandable metal stents in benign biliary strictures: Midterm evaluation (with video). Gastrointestinal Endoscopy, 70(2), 303–309.

    Article  PubMed  Google Scholar 

  17. Tarantino, I., Traina, M., Mocciaro, F., et al. (2012). Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation. Endoscopy, 44(3), 246–250.

    Article  CAS  PubMed  Google Scholar 

  18. Freeman, M. F., & Tukey, J. W. (1950). Transformations related to the angular and the square root. The Annals of Mathematical Statistics, 21, 607–611.

    Article  Google Scholar 

  19. DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3), 177–188.

    Article  CAS  PubMed  Google Scholar 

  20. Hu, B., Gao, D. J., Yu, F. H., et al. (2011). Endoscopic stenting for post-transplant biliary stricture: Usefulness of a novel removable covered metal stent. Journal of Hepatobiliary Pancreatic Sciences, 18(5), 640–645.

    Article  PubMed  Google Scholar 

  21. Verdonk, R. C., Buis, C. I., Porte, R. J., et al. (2006). Anastomotic biliary strictures after liver transplantation: Causes and consequences. Liver Transplantation, 12(5), 726–735.

    Article  PubMed  Google Scholar 

  22. Costamagna, G., Pandolfi, M., Mutignani, M., et al. (2001). Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointestinal Endoscopy, 54(2), 162–168.

    Article  CAS  PubMed  Google Scholar 

  23. Morelli, G., Fazel, A., Judah, J., et al. (2008). Rapid-sequence endoscopic management of posttransplant anastomotic biliary strictures. Gastrointestinal Endoscopy, 67(6), 879–885.

    Article  PubMed  Google Scholar 

  24. Buxbaum, J. L., Biggins, S. W., Bagatelos, K. C., et al. (2011). Predictors of endoscopic treatment outcomes in the management of biliary problems after liver transplantation at a high-volume academic center. Gastrointestinal Endoscopy, 73(1), 37–44.

    Article  PubMed  Google Scholar 

  25. Kahaleh, M., Behm, B., Clarke, B. W., et al. (2008). Temporary placement of covered self-expandable metal stents in benign biliary strictures: A new paradigm? (with video). Gastrointestinal Endoscopy, 67(3), 446–454.

    Article  PubMed  Google Scholar 

  26. Chaput, U., Scatton, O., Bichard, P., et al. (2010). Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: A prospective, multicenter study. Gastrointestinal Endoscopy, 72(6), 1167–1174.

    Article  PubMed  Google Scholar 

  27. García-Pajares, F., Sánchez-Antolín, G., et al. (2010). Covered metal stents for the treatment of biliary complications after orthotopic liver transplantation. Transplantation Proceedings, 42(8), 2966–2969.

    Article  PubMed  Google Scholar 

  28. Tarantino, I., Traina, M., Mocciaro, F., et al. (2012). Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation. Endoscopy, 44(3), 246–250.

    Article  CAS  PubMed  Google Scholar 

  29. Coté, G. A., Kumar, N., Ansstas, M., et al. (2010). Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents. Gastrointestinal Endoscopy, 72(4), 748–754.

    Article  PubMed  Google Scholar 

  30. Bourgeois, N., Deviére, J., Yeaton, P., et al. (1995). Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation. Gastrointestinal Endoscopy, 42(6), 527–534.

    Article  CAS  PubMed  Google Scholar 

  31. Solmi, L., Cariani, G., Leo, P., et al. (2007). Results of endoscopic retrograde cholangiopancreatography in the treatment of biliary tract complications after orthotopic liver transplantation: Our experience. Hepato-Gastroenterology, 54(76), 1004–1008.

    PubMed  Google Scholar 

  32. Elmi, F., & Silverman, W. B. (2007). Outcome of ERCP in the management of duct-to-duct anastomotic strictures in orthotopic liver transplant. Digestive Diseases and Sciences, 52(9), 2346–2350.

    Article  PubMed  Google Scholar 

  33. Polese, L., Cillo, U., Brolese, A., et al. (2007). Endoscopic treatment of bile duct complications after orthotopic liver transplantation. Transplantation Proceedings, 39(6), 1942–1944.

    Article  CAS  PubMed  Google Scholar 

  34. Chahin, N. J., De Carlis, L., Slim, A. O., et al. (2001). Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation. Transplantation Proceedings, 33(5), 2738–2740.

    Article  CAS  PubMed  Google Scholar 

  35. Pasha, S. F., Harrison, M. E., Das, A., et al. (2007). Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: Outcomes after maximal stent therapy. Gastrointestinal Endoscopy, 66(1), 44–51.

    Article  PubMed  Google Scholar 

  36. Mahajani, R. V., Cotler, S. J., & Uzer, M. F. (2000). Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation. Endoscopy, 32(12), 943–949.

    Article  CAS  PubMed  Google Scholar 

  37. Rerknimitr, R., Sherman, S., Fogel, E. L., et al. (2002). Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: Endoscopic findings and results of therapy. Gastrointestinal Endoscopy, 55(2), 224–231.

    Article  PubMed  Google Scholar 

  38. Boskoski, I., Tringali, A., Landi, R., et al. (2012). Endotherapy of anastomotic strictures after orthotopic liver transplantation with multiple plastic stents: Long term follow-up. Digestive and Liver Disease, 44, A8.

    Google Scholar 

  39. Putta, S., Sagar, V., Gunson, B., et al. (2011). Long-term efficacy and safety of endotherapy for management of biliary anastamotic strictures following liver transplantation. Gut, 60, A40.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, The Drum Tower Hospital Affiliated to Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People’s Republic of China

    Chunyan Peng, Guifang Xu, Shanshan Shen, Ying Lv & Xiaoping Zou

  2. Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China

    Chunyan Peng & Chao Ma

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  1. Chunyan Peng
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  2. Chao Ma
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Correspondence to Xiaoping Zou.

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Chunyan Peng and Chao Ma consider are co-first authors.

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Peng, C., Ma, C., Xu, G. et al. The Efficacy and Safety of Endoscopic Balloon Dilation Combined with Stenting in Patients with Biliary Anastomotic Strictures After Orthotopic Liver Transplantation. Cell Biochem Biophys 72, 385–397 (2015). https://doi.org/10.1007/s12013-014-0473-8

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  • DOI: https://doi.org/10.1007/s12013-014-0473-8

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