Endo‐therapies for biliary duct‐to‐duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey.

Background: The most appropriate endo‐therapeutic approach to biliary anastomotic strictures is yet to be defined. Aim: To retrospectively report on the endo‐therapy of duct‐to‐duct anastomotic strictures during 2013 in Italy. Methods: Data were collected from 16 Endoscopy Units at the Italian Liver Transplantation Centers (BASALT study group). Results: Complete endo‐therapy and follow‐up data are available for 181 patients: 101 treated with plastic multistenting, 26 with fully covered self‐expandable metal stenting and 54 with single stenting. Radiological success was achieved for 145 patients (80%), that is, 88% of plastic multistenting, 88% of self‐expandable metal stenting and 61% of single stenting (P < 0.001 vs plastic multistenting; P < 0.05 vs self‐expandable metal stenting). After first‐line endo‐therapy failure, the patients underwent a second‐line endo‐therapy with plastic multistenting for 25%, fully covered self‐expandable metal stenting for 53% and single stenting for 22% of cases, and radiological success was achieved for 84%, that is, 100%, 85% and 63% with plastic multistenting, self‐expandable metal stenting and single stenting (P < 0.05 vs plastic multistenting or self‐expandable metal stenting) respectively. Procedure‐related complications occurred in 7.8% of endoscopic retrograde cholangiopancreatographies. Overall, clinical success was achieved in 87% of patients after a median follow‐up of 25 months. Conclusion: Plastic multistenting is confirmed as the preferred first‐line treatment, while fully covered self‐expandable metal stenting as rescue option for biliary anastomotic strictures. Single stenting has sub‐optimal results and should be abandoned. See Editorial on Page 1197 [ABSTRACT FROM AUTHOR]