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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Apr 30, 2019; 7(4): 120-128
Published online Apr 30, 2019. doi: 10.13105/wjma.v7.i4.120
Endoscopic management of biliary strictures post-liver transplantation
Ahmed Akhter, Patrick Pfau, Mark Benson, Anurag Soni, Deepak Gopal
Ahmed Akhter, Patrick Pfau, Mark Benson, Anurag Soni, Deepak Gopal, Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
Author contributions: All authors contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Deepak Gopal, MD, FRCP (C), FASGE, FACP, FACG, AGAF, Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, 1685 Highland Avenue, Madison, WI 53705, United States. dvg@medicine.wisc.edu
Telephone: +1-608-2637322 Fax: +1-608-2655677
Received: February 22, 2019
Peer-review started: February 22, 2019
First decision: April 13, 2019
Revised: April 22, 2019
Accepted: April 23, 2019
Article in press: April 23, 2019
Published online: April 30, 2019
Processing time: 67 Days and 7.3 Hours
Abstract

Biliary complications play a significant role in morbidity of liver transplant recipients. Biliary strictures occur between 10%-25% of patients with a higher incidence in living donor recipients compared to deceased donors. Strictures can be classified as either anastomotic or non-anastomotic and may be related to ischemic events. Endoscopic management of biliary strictures in the post-transplant setting has become the preferred initial approach due to adequate rates of resolution of anastomotic and non-anastomotic strictures (NAS). However, several factors may increase complexity of the endoscopic approach including surgical anatomy, location, number, and severity of bile duct strictures. Many endoscopic tools are available, however, the approach to management of anastomotic and NAS has not been standardized. Multi-disciplinary techniques may be necessary to achieve optimal outcomes in select patients. We will review the risk factors associated with the development of bile duct strictures in the post-transplant setting along with the efficacy and complications of current endoscopic approaches available for the management of bile duct strictures.

Keywords: Liver transplantation; Endoscopic management; Anastomosis; Biliary strictures; Biliary balloon dilation; Biliary stents

Core tip: Biliary strictures occur between 10%-25% of patients with a higher incidence in living donor recipients compared to deceased donors. Strictures can be classified as either anastomotic or non-anastomotic and may be related to ischemic events. Many endoscopic tools are available, however, the approach to management of anastomotic and non-anastomotic strictures has not been standardized. We will review the risk factors associated with the development of bile duct strictures in the post-transplant setting along with the efficacy and complications of current endoscopic approaches available for the management of bile duct strictures.