A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation

Background. Biliary anastomotic strictures are a common complication of liver transplantation, occurring in up to 7% of patients at our center. Endoscopic therapy has started to replace surgical biliary reconstruction as the favored means of managing these patients in some centers, although the utility of this approach has never been tested in the setting of a standardized prospective study. Methods. This was a standardized, prospective observational study in the liver transplantation unit, Queen Elizabeth Hospital, Birmingham, United Kingdom. Between June 2000 and August 2006, a total of 791 adults underwent liver transplantation at the Birmingham liver unit and 53 patients were diagnosed with biliary anastomotic strictures. All 53 patients chose to undergo endoscopic therapy and were managed according to the unit's standardized treatment protocol. Data and information from the patient records was collated prospectively, stored in a specific database, and analyzed by intention-to-treat. Results. Endoscopic therapy was successful in 69% of patients referred with anastomotic strictures with a median stent free follow up of 18 months. Most patients required a median of 3 endoscopic procedures and two 24F balloon dilatations to adequately treat the stricture. The median continuous indwelling stent period was 11 months. Two patients were re-stented because of jaundice although only one patient had recurrence of the anastomotic stricture (3%). Conclusions. Endoscopic balloon dilatation and stenting is a safe and effective means of treating biliary anastomotic strictures complicating liver transplantation.