Endoscopic Treatment of Biliary Strictures After LTX: Balloon Dilatation Versus Stent Placement
Endoscopic Treatment of Biliary Strictures After LTX: Balloon Dilatation Versus Stent Placement
Background and Study Aims: Biliary strictures are a major cause of morbidity following liver
 transplantation with an overall incidence between 10 and 30 %. Up to now biliary strictures
 were dilated subsequently one to three plastic stents with a diameter of eight to ten F were
 inserted. In general, stents were exchanged in two to three months intervals over one year.
 In the present prospective controlled study, efficacy and complication rates of balloon
 dilation have been compared with dilation plus stenting.

 Patients and Methods: XY patients with high-grade biliary strictures (anastomotic and
 non-anastomotic) were enrolled in this prospective study in random order. X patients were
 treated by endoscopic balloon dilatation and Y by balloon dilatation plus plastic stent
 placement in six to eight weeks intervals. The primary end point was permanent opening of the
 biliary obstruction of 12 months. Number of endoscopic interventions and complications of the
 procedures were monitored.
Endoscopic treatment was performed by experienced endoscopists who had each performed more
 than 1000 ERCP procedures. The procedure was performed with the patient under general
 anesthesia with propofol. A stenosis was considered to be present if the cholangiogram showed
 strictures with a narrowing of the anastomosis or the proximal donor duct site of the
 anastomosis and incomplete distal runoff of the contrast agent.

 The patients were divided into two groups: 1) balloon dilatation of the stricture, 2) balloon
 dilatation plus plastic stent placement.

 In both groups, endoscopic treatment of the patients comprised sphincterotomy, consecutive
 dilation of stenosis up to 10 F, removement of occluding material from choledochus duct using
 a balloon catheter if necessary, and repetitive balloon dilatation of the anastomosis
 stricture or of the non-anastomotic proximal donor duct stricture to 18 F at the first
 intervention and to 24 F in the following interventions.

 The second group of the patients were additionally treated by large-diameter (10 F) plastic
 stent placement after balloon dilatation. This procedure was repeated in 6 - 8 weeks
 intervals in both groups.
Inclusion Criteria:

 -  liver transplanted patients with diagnosis of biliary obstruction based on endoscopic
 cholangiopancreaticography older than 18 years male and female

 Exclusion Criteria:

 -  patients with multiple organ transplantation