A prospective study of standardized nonsurgical therapy in the management of biliary XXXX complicating liver transplantation.

@entity1 @entity850 @entity1087
BACKGROUND: Biliary @entity850 are a common complication of liver transplantation, occurring in up to 7% of @entity1 at our center. Endoscopic therapy has started to replace surgical biliary reconstruction as the favored means of managing these @entity1 in some centers, although the utility of this approach has never been tested in the setting of a standardized prospective study. METHODS: This was a standardized, prospective observational study in the liver transplantation unit, Queen Elizabeth Hospital, Birmingham, United Kingdom. Between June 2000 and August 2006, a total of 791 adults underwent liver transplantation at the Birmingham liver unit and 53 @entity1 were diagnosed with biliary @entity850 . All 53 @entity1 chose to undergo endoscopic therapy and were managed according to the unit's standardized treatment protocol. Data and information from the @entity1 records was collated prospectively, stored in a specific database, and analyzed by intention-to-treat. RESULTS: Endoscopic therapy was successful in 69% of @entity1 referred with @entity850 with a median stent free follow up of 18 months. Most @entity1 required a median of 3 endoscopic procedures and two 24F balloon dilatations to adequately treat the stricture. The median continuous indwelling stent period was 11 months. Two @entity1 were re-stented because of @entity1087 although only one @entity1 had recurrence of the anastomotic stricture (3%). CONCLUSIONS: Endoscopic balloon dilatation and stenting is a safe and effective means of treating biliary @entity850 complicating liver transplantation.
