AB051. SOH26AB_0087. Management of anastomotic biliary strictures post orthotopic liver transplantation: a 4-year review
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AB051. SOH26AB_0087. Management of anastomotic biliary strictures post orthotopic liver transplantation: a 4-year review

Alex Start1, Cormac Hegarty1, Afaf Ahmad1, Hugh Mulcahy2, Fergal Donnellan2, Mohamed Hamid2, Emir Hoti3, Audrey Dillon1

1National Liver Transplantation Unit, St. Vincent’s University Hospital, Dublin, Ireland; 2Department of Gastroenterology, St. Vincent’s University Hospital, Dublin, Ireland; 3Department of Hepatobiliary Surgery, St. Vincent’s University Hospital, Dublin, Ireland

Background: Anastomotic biliary strictures are a common complication of orthotopic liver transplantation (OLT), resulting in significant morbidity and mortality. Current management strategies suggest endoscopic retrograde cholangiopancreatography (ERCP) as first line, followed by drain insertion, and surgical reconstruction, hepaticojejunostomy (hep-jej). The aim of this study is to evaluate the management approaches to post-OLT anastomotic strictures in Ireland’s National Liver Unit (January 2019–October 2023).

Methods: This is a prospective study of post-OLT patients with biliary stricture, with data obtained from a prospectively maintained transplant database and individual chart reviews.

Results: Forty-two of 228 transplanted patients (18.4%) had biliary strictures identified. Twenty-six point two percent (11/42) underwent primary surgical reconstruction. Of those, 90.9% (10/11) had resolution, whilst one patient required further drain insertion and balloon dilatation with a good outcome. Of the 30 patients that had ERCP, only 13.3% (4/30) had resolution within 12 months of intervention with no recurrence. Of the remaining patients who did not respond to ERCP (n=26), 8/26 had hep-jej and 4/26 had drain insertion. Two had ongoing ERCPs at time of data collection. Twelve failed ERCP. Nine patients required >12 months of interventions, of which 4 had endoscopic resolution. Twenty-three point three percent (7/30) of ERCP patients experienced complications: post-ERCP pancreatitis (5/30), upper gastrointestinal bleeding (1/30), and small bowel obstruction secondary to stent migration (1/30).

Conclusions: Anastomotic strictures post-OLT frequently require repeat interventions with hep-jej demonstrating the highest efficacy. The National Liver Transplant Unit has since created a new pathway for patients with anastomotic strictures, with defined repeat ERCP intervals and stent recommendations, and earlier referral to hep-jej.

Keywords: Anastomotic strictures; endoscopic retrograde cholangiopancreatography (ERCP); hepaticojejunostomy (hep-jej); liver transplantation; surgical complications

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab051
Cite this abstract as: Start A, Hegarty C, Ahmad A, Mulcahy H, Donnellan F, Hamid M, Hoti E, Dillon A. AB051. SOH26AB_0087. Management of anastomotic biliary strictures post orthotopic liver transplantation: a 4-year review. Mesentery Peritoneum 2026;10:AB051.

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