Long-term outcomes of post-transplant biliary anastomotic strictures: Endoscopic therapy with plastic and metal stents

doi:10.4253/wjge.v17.i6.103183

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World Journal of Gastrointestinal Endoscopy

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World J Gastrointest Endosc. Jun 16, 2025; 17(6): 103183
Published online Jun 16, 2025. doi: 10.4253/wjge.v17.i6.103183

Long-term outcomes of post-transplant biliary anastomotic strictures: Endoscopic therapy with plastic and metal stents

Ermelindo Della Libera, Gustavo Andrade De Paulo, Edmar Tafner, Angelo Paulo Ferrari, Fernanda Prata Martins, Larissa Wermelinger Pinheiro

Larissa Wermelinger Pinheiro, Angelo Paulo Ferrari, Ermelindo Della Libera, Gastroenterology Division of Escola Paulista de Medicina, São Paulo Federal University, São Paulo 04039-032, Brazil

Fernanda Prata Martins, Angelo Paulo Ferrari, Edmar Tafner, Gustavo Andrade De Paulo, Ermelindo Della Libera, Digestive Endoscopy Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil

Author contributions: Pinheiro LW was responsible for data acquisition, analysis and interpretation, and elaboration of article draft; Martins FP and Tafner E were responsible for data acquisition, elaboration and review of the article draft, and reviewing critically for important intellectual content; De Paulo GA was responsible for data acquisition, analysis and interpretation, and critical review of the final paper for important intellectual content; Ferrari AP and Libera ED were responsible for data analysis and interpretation, critical review, and approval of the final submitted version; All authors read and approved the final version of the manuscript to be published.

Institutional review board statement: This study was approved by the Ethics Committee of the Israelita Albert Einstein Hospital.

Informed consent statement: Patients were required to provide informed consent to the study according to the requirements of the committee of the Israelita Albert Einstein Hospital.

Conflict-of-interest statement: The authors have no conflicting relationships to disclose.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: No additional data are available.

Corresponding author: Ermelindo Della Libera, MD, PhD, Gastroenterology Division of Escola Paulista de Medicina, São Paulo Federal University, Rua Pedro de Toledo, 861/869-Vila Clementino, São Paulo 04039-032, Brazil. edellaliberajr@uol.com.br

Received: November 11, 2024
Revised: April 1, 2025
Accepted: May 18, 2025
Published online: June 16, 2025
Processing time: 212 Days and 8.8 Hours

Abstract

BACKGROUND

Biliary anastomotic stricture (BAS) occurs in approximately 14%-20% of patients post-orthotopic liver transplantation (post-OLT). Endoscopic retrograde cholangiopancreatography (ERCP) using multiple plastic stents (MPSs) or fully covered self-expandable metal stents (cSEMSs) represent the standard treatment for BAS post-OLT. Recently, cSEMSs have emerged as the primary option for managing BAS post-OLT.

AIM

To compare the resolution and recurrence of BAS rates in these patients.

METHODS

This retrospective cohort study was conducted in a single tertiary care center (Hospital Israelita Albert Einstein, São Paulo, Brazil). We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022. Patients were stratified into two groups according to therapy: (1) MPSs; and (2) cSEMSs. Primary endpoints were to compare stricture resolution and recurrence among the groups. The secondary endpoint was to identify predictive factors for stricture recurrence.

RESULTS

A total of 104 patients were included. Overall stricture resolution was 101/104 (97.1%). Stricture resolution was achieved in 83/84 patients (99%) in the cSEMS group and 18/20 patients (90%) in the MPS group (P = 0.094). Failure occurred in 3/104 patients (2.8%). Stricture recurrence occurred in 9/104 patients (8.7%). Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups (P = 0.201). A multivariate analysis identified the number of ERCP procedures (hazard ratio = 1.4; 95% confidence interval: 1.194-1.619; P < 0.001] and complications (hazard ratio = 2.8; 95% confidence interval: 1.008-7.724; P = 0.048) as predictors of stricture recurrence.

CONCLUSION

cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence. The number of ERCP procedures and complications were predictors of stricture recurrence.

Keywords: Liver transplantation; Biliary stricture; Endoscopic retrograde cholangiopancreatography; Stents; Benign

Core Tip: This retrospective study evaluated the resolution and recurrence of endoscopic treatment using multiple plastic stents (MPSs) and covered self-expandable metal stents (cSEMSs) in patients with post-orthotopic liver transplantation (OLT) biliary anastomotic stricture. Patients were stratified into two groups according to therapy: (1) MPSs; and (2) cSEMSs. Stricture resolution occurred in 101/104 patients (97.1%). Adverse events occurred in 48% in the cSEMS group and 10% in the MPS group. The cSEMSs and MPSs were effective and comparable regarding biliary anastomotic strictures post-OLT.