The role of endoscopic retrograde cholangiography for biliary stricture after adult living donor liver transplantation: Technical aspect and outcome

Objective. Biliary strictures, occurring after living donor liver transplantation (LDLT) with duct-to-duct biliary reconstruction, are usually treated by endoscopic retrograde cholangiography (ERC); nevertheless, its therapeutic value is still under evaluation. The aim of this study was to describe technical aspects of ERC in treating biliary strictures and evaluate their outcomes. Material and methods. A total of 147 patients who underwent ERC for biliary strictures distal to left and right main hepatic ducts occurring after LDLT performed between January 2004 and March 2007 were retrospectively analyzed. Biliary strictures were treated by both balloon dilation and stenting in consecutive ERC sessions. Then, we evaluated immediate and final endoscopic success rates. Results. Immediate endoscopic success was achieved in 82/147 (55.8%) patients and final endoscopic success in 52/141 (36.9%). An average of 6.3 endoscopic sessions and 12.7 months were required to achieve final endoscopic success. ERC-related complications including death in one patient occurred in about 7.2%. Mean recurrence-free period after final endoscopic success was 21.5 months, with six (11.5%) patients having a relapse of biliary strictures. Final endoscopic success group compared with failure group showed significantly later occurrence of biliary strictures after LDLT. Conclusions. Achieving final endoscopic success using ERC alone for treating post-LDLT biliary strictures distal to left and right main hepatic ducts is rather difficult, although outcomes are improving with time. Strategies are thought to be needed to improve outcomes such as technical/instrumental improvement.