Divyanshoo R Kohli1, M E Harrison2, Tala Mujahed3, Norio Fukami2, Douglas O Faigel2, Rahul Pannala2, Adyr Moss4, Bashar A Aqel2. 1. Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States; Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, MO, United States. Electronic address: kohli015@gmail.com. 2. Division of Gastroenterology and Hepatology, Mayo Clinic, AZ, United States. 3. Mayo Clinic School of Medicine, Mayo Clinic, AZ, United States. 4. Department of Surgery, Mayo Clinic, AZ, United States.
Abstract
BACKGROUND: Biliary strictures after donation-after-cardiac-death (DCD) liver transplantation (LT) require multiple endoscopic retrograde cholangiopancreatographies (ERCP). The outcomes of endoscopic dilation and maximal stenting are not well-characterized in this high-risk population. METHODS: DCD LT recipients who underwent LT and ERCP from 2012-2018 were selected. Anastomotic and non-anastomotic strictures were treated with balloon dilation and maximal stenting. A successful stent-free trial was defined as absence of biochemical, clinical or imaging evidence of strictures on follow-up exceeding 6 months. Adverse events were defined as unplanned admission or inpatient evaluation within 7 days of ERCP. RESULTS: Forty-nine DCD LT recipients underwent ERCP and 34 patients were diagnosed with strictures (20 anastomotic). Stent-free trial was successful in 27 patients. Adverse events occurred after 20 ERCPs. Patients with anastomotic strictures required fewer stents (1.43 ± 1.37 vs 2.63 ± 1.66; P < 0.001), shorter procedure and fluoroscopy times (34.15 ± 20.9 vs 59.6 ± 30.7 minutes, P < 0.001; 5.99 ± 7.4 vs 14.73 ± 10.74 minutes, P < 0.001), fewer relapses (10% vs 57%, P = 0.003), shorter intervals between initial ERCP and stent-free success (136.9 ± 118.3 vs 399.56 ± 234.7; P = 0.003), and between LT and stent-free success (227.8 ± 171.9 vs 464.1 ± 224.6 days; P = 0.005) compared to non-anastomotic strictures. CONCLUSION: Endoscopic dilation and maximal stenting resolves biliary strictures in DCD LT recipients with sustained success and relatively few adverse events. Published by Elsevier Ltd.
BACKGROUND: Biliary strictures after donation-after-cardiac-death (DCD) liver transplantation (LT) require multiple endoscopic retrograde cholangiopancreatographies (ERCP). The outcomes of endoscopic dilation and maximal stenting are not well-characterized in this high-risk population. METHODS: DCD LT recipients who underwent LT and ERCP from 2012-2018 were selected. Anastomotic and non-anastomotic strictures were treated with balloon dilation and maximal stenting. A successful stent-free trial was defined as absence of biochemical, clinical or imaging evidence of strictures on follow-up exceeding 6 months. Adverse events were defined as unplanned admission or inpatient evaluation within 7 days of ERCP. RESULTS: Forty-nine DCD LT recipients underwent ERCP and 34 patients were diagnosed with strictures (20 anastomotic). Stent-free trial was successful in 27 patients. Adverse events occurred after 20 ERCPs. Patients with anastomotic strictures required fewer stents (1.43 ± 1.37 vs 2.63 ± 1.66; P < 0.001), shorter procedure and fluoroscopy times (34.15 ± 20.9 vs 59.6 ± 30.7 minutes, P < 0.001; 5.99 ± 7.4 vs 14.73 ± 10.74 minutes, P < 0.001), fewer relapses (10% vs 57%, P = 0.003), shorter intervals between initial ERCP and stent-free success (136.9 ± 118.3 vs 399.56 ± 234.7; P = 0.003), and between LT and stent-free success (227.8 ± 171.9 vs 464.1 ± 224.6 days; P = 0.005) compared to non-anastomotic strictures. CONCLUSION: Endoscopic dilation and maximal stenting resolves biliary strictures in DCD LT recipients with sustained success and relatively few adverse events. Published by Elsevier Ltd.
Authors: Divyanshoo R Kohli; Rahul Pannala; Michael D Crowell; Norio Fukami; Douglas O Faigel; Bashar A Aqel; M Edwyn Harrison Journal: Dig Dis Sci Date: 2020-03-03 Impact factor: 3.199
Authors: Matthew Fasullo; Priyanush Kandakatla; Reza Amerinasab; Divyanshoo Rai Kohli; Tilak Shah; Samarth Patel; Chandra Bhati; Doumit Bouhaidar; Mohammad S Siddiqui; Ravi Vachhani Journal: Ann Hepatobiliary Pancreat Surg Date: 2022-02-28