Endoscopic management of post-living donor liver transplant anastomotic biliary strictures: A quaternary care transplant center experience

Figure 1 Gadgets used during Endoscopic retrograde cholangiopancreatography to dilate the strictures. A: Soehendra dilators of various sizes; B: Biliary dilatation balloons of various sizes.

Figure 2 Management algorithm for anastomotic biliary strictures. ¹Cholangioscopy was utilized to facilitate traversal of acutely angulated strictures, enable drainage of sectoral branches, and confirm stricture resolution. ²Failure of stricture resolution was defined as the persistence of the stricture despite 12 months of endoscopic therapy. ³Percutaneous transhepatic cholangiography was employed in cases where primary endoscopic retrograde cholangiopancreatography or cholangioscopy failed, as well as for sectoral duct strictures that were not amenable to endoscopic management. ABS: Anastomotic biliary strictures; ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 3 Incidence of biliary strictures across different reconstruction techniques.

Figure 4 Participant flow diagram. LDLT: Living donor liver transplantation; ABS: Anastomotic biliary strictures; ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 5 Timelines between liver transplant to first endoscopic retrograde cholangiopancreatigraphy and post-resolution stricture recurrence. ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 6 Comparison of endoscopic retrograde cholangiopancreatography sessions required to achieve resolution for various types of biliary reconstructions. ERCP: Endoscopic retrograde cholangiopancreatography.