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ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

Authors :
Lucas Souto NACIF
Wanderley Marques BERNARDO
Luca BERNARDO
Wellington ANDRAUS
Lucas TORRES
Eleazar CHAIB
Luiz Carneiro D'ALBUQUERQUE
Fauze MALUF-FILHO
Source :
Arquivos de Gastroenterologia, Vol 51, Iss 3, Pp 240-249
Publisher :
Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia (IBEPEGE).

Abstract

Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.

Details

Language :
English
ISSN :
16784219 and 00042803
Volume :
51
Issue :
3
Database :
Directory of Open Access Journals
Journal :
Arquivos de Gastroenterologia
Publication Type :
Academic Journal
Accession number :
edsdoj.9aec17cac0b24cb182496e62d9efba01
Document Type :
article
Full Text :
https://doi.org/10.1590/S0004-28032014000300014