PDF | https://doi.org/10.46613/congastro2023-122
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VARGAS J1, Espino A1, Richter H1, Meneses L1, Palma R1, Briceño E1, Viñuela E1, Martinez J1, Jarufe N1, Cancino A1, Diaz P1, Huete A1, Hevia J1, Beza C1, Díaz L1, Wolff R1, Norero B1, Barrera F1, Soza A1, Arrese M1, Arab J1, Benítez C1, Dib M1
1PONTIFICIA UNIVERSIDAD CATOLICA DE CHILE, Santiago, Chile
BACKGROUND:
Liver transplantation (LT) offers lifesaving therapy for patients with advanced liver disease. Anastomotic bile duct strictures (ABDS) are a frequent adverse event of LT and most are suitable for endoscopic treatment by Endoscopic retrograde cholangiopancreatography (ERCP). Single-operator cholangioscopy (SOC-ERCP) is an emergent technique for the management of complex biliary disease. Data about its role in ABDS after LT are scarce.
AIM: to evaluate the role/efficacy of the use of SOC in management of ABDS after LT.
METHODS:
Single-center prospective cohort study. All patients undergoing LT in Hospital Clinico UC-CHRISTUS (Santiago, Chile) between January/2021 and June/2023 were included. Demographic, clinical, laboratory and radiology data were considered. Outcomes: rate of ABDS, success rate of conventional ERCP, efficacy of SOC-ERCP, technical/clinical success, and adverse events.
RESULTS:
136 patients underwent LT during the study period. Mean age was 51 years, 59% female, most frequent etiology was metabolic dysfunction-associated steatotic liver disease (MASLD) (31.1%) and mean MELD score before LT was 27.7; 73.5% (100/136) were deceased donor LT (DDLT) and 26.5% (36/136) were living donor LT (LDLT).
54/136 (39%) patients developed ABDS. No difference in occurrence of ABDS was seen between DDLT and LDLT (39%(39/100) vs 42%(15/36), p0.05). 4%(2/54) of ABDS underwent primary interventional radiology treatment (IR) based on biliary anatomy. Treatment of ABDS by conventional ERCP was successful in 81% (42/52). Patients with ABDS that failed conventional ERCP, 12%(6/52) were treated successfully with SOC-ERCP, 4%(2/52) underwent successful one-session combined IR-ERCP treatment and 2%(1/52) required surgical biliary reconstruction. Technical and clinical success of SOC-ERCP was 100% in both DDLT and LDLT. No adverse events were recorded during SOC-ERCP.
CONCLUSIONS:
SOC-ERCP is a novel, safe and effective tool in the management of complex ABDS after failed conventional ERCP in LT patients.