Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 14, 2009; 15(30): 3725-3733
Published online Aug 14, 2009. doi: 10.3748/wjg.15.3725
Endoscopic management of biliary strictures after liver transplantation
Emmanuelle D Williams, Peter V Draganov
Emmanuelle D Williams, Peter V Draganov, Division of Gastroenterology, University of Florida, Gainesville, FL 32610-0214, United States
Author contributions: Williams ED performed the literature search and wrote the first draft of the paper; Draganov PV designed the concept and format of the paper, contributed to the literature search and edited the article.
Correspondence to: Peter V Draganov, MD, Assistant Professor, Division of Gastroenterology, University of Florida, Hepatology and Nutrition, Room HD 602, PO Box 100214, Gainesville, FL 32610-0214, United States.
Telephone: +1-352-3922877
Fax: +1-352-3923618
Received: April 14, 2009
Revised: July 9, 2009
Accepted: July 16, 2009
Published online: August 14, 2009

Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classified as anastomotic or non-anastomotic strictures according to location and are defined by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Non-anastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is significant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.

Keywords: Anastomotic strictures, Bile duct diseases, Endoscopic retrograde cholangiopancreatography, Orthotopic liver transplantation, Surgical anastomosis