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. 2025 Jun 16;17(6):103183.
doi: 10.4253/wjge.v17.i6.103183.

Long-term outcomes of post-transplant biliary anastomotic strictures: Endoscopic therapy with plastic and metal stents

Larissa Wermelinger Pinheiro  1 , Fernanda Prata Martins  2 , Angelo Paulo Ferrari  1   2 , Edmar Tafner  2 , Gustavo Andrade De Paulo  2 , Ermelindo Della Libera  1   3
Affiliations

Long-term outcomes of post-transplant biliary anastomotic strictures: Endoscopic therapy with plastic and metal stents

Larissa Wermelinger Pinheiro et al. World J Gastrointest Endosc. .

Abstract

Background: Biliary anastomotic stricture (BAS) occurs in approximately 14%-20% of patients post-orthotopic liver transplantation (post-OLT). Endoscopic retrograde cholangiopancreatography (ERCP) using multiple plastic stents (MPSs) or fully covered self-expandable metal stents (cSEMSs) represent the standard treatment for BAS post-OLT. Recently, cSEMSs have emerged as the primary option for managing BAS post-OLT.

Aim: To compare the resolution and recurrence of BAS rates in these patients.

Methods: This retrospective cohort study was conducted in a single tertiary care center (Hospital Israelita Albert Einstein, São Paulo, Brazil). We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022. Patients were stratified into two groups according to therapy: (1) MPSs; and (2) cSEMSs. Primary endpoints were to compare stricture resolution and recurrence among the groups. The secondary endpoint was to identify predictive factors for stricture recurrence.

Results: A total of 104 patients were included. Overall stricture resolution was 101/104 (97.1%). Stricture resolution was achieved in 83/84 patients (99%) in the cSEMS group and 18/20 patients (90%) in the MPS group (P = 0.094). Failure occurred in 3/104 patients (2.8%). Stricture recurrence occurred in 9/104 patients (8.7%). Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups (P = 0.201). A multivariate analysis identified the number of ERCP procedures (hazard ratio = 1.4; 95% confidence interval: 1.194-1.619; P < 0.001] and complications (hazard ratio = 2.8; 95% confidence interval: 1.008-7.724; P = 0.048) as predictors of stricture recurrence.

Conclusion: cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence. The number of ERCP procedures and complications were predictors of stricture recurrence.

Keywords: Benign; Biliary stricture; Endoscopic retrograde cholangiopancreatography; Liver transplantation; Stents.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicting relationships to disclose.

Figures

Figure 1
Figure 1
Treatment with multiple plastic stents. A: Cholangiogram showed a post-liver transplant biliary anastomotic stricture; B: Endoscopic view of multiple plastic stents placed in parallel.
Figure 2
Figure 2
Treatment with a fully covered self-expanding metal stent. A: Cholangiogram showed a biliary anastomotic stricture after liver transplantation; B: Immediate post-placement image of the covered self-expandable metal stents; C: Endoscopic view of the covered self-expandable metal stents.
Figure 3
Figure 3
Flowchart of patients with post-orthotopic liver transplantation biliary anastomotic stricture treated with fully covered self-expandable metal stents or multiple plastic stents. cSEMSs: Covered self-expandable metal stents; ERCP: Endoscopic retrograde cholangiopancreatography; MPSs: Multiple plastic stents.
Figure 4
Figure 4
Stricture resolution between the groups. cSEMSs: Covered self-expandable metal stents; MPSs: Multiple plastic stents.
Figure 5
Figure 5
Kaplan-Meier analysis of stricture resolution/freedom from recurrence showed no difference in recurrence-free time between the groups. cSEMSs: Covered self-expandable metal stents; MPSs: Multiple plastic stents.
See this image and copyright information in PMC

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