Percutaneous Management of Benign Biliary Strictures with Large-Bore Catheters: Comparison between Patients with and without Orthotopic Liver Transplantation

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• 作者：Johannes M. Ludwig ; MD^a ; Grant R. Webber ; MD^b ; Stuart J. Knechtle ; MD^d ; James R. Spivey ; MD^c ; Minzhi Xing ; MD^a ; Hyun S. Kim ; MD^a ; ^{kevin.kim@yale.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ALT ; alanine aminotransferase ; AST ; aspartate aminotransferase ; ERCP ; endoscopic retrograde cholangiopancreatography ; OLT ; orthotopic liver transplantation ; PSC ; primary sclerosing cholangitis
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：27
• 期：2
• 页码：219-225.e1
• 全文大小：514 K

文摘

To prospectively evaluate stricture resolution and patency rates of benign biliary strictures treated with percutaneous large-bore catheter “stenting” in patients with and without previous orthotopic liver transplantation (OLT) and to compare treatment outcomes between these two groups.

Materials and Methods

Forty-six consecutive patients (25 with OLT) underwent percutaneous catheter placement in extrahepatic and single-site biliary stricture for 6–8 months, with progressive catheter upsizing to 18–20 F. Primary patency rate was defined as the proportion of patients without recurrent bile duct stricture during the follow-up period after successful stricture resolution. Secondary patency rate was defined as the proportion of patients with a patent bile duct at the end of follow-up after stricture resolution, including patients with stricture recurrence and successful repeat percutaneous biliary catheter treatment.

Results

Eleven patients terminated the protocol early, 6 as a result of treatment-related reasons in the orthotopic liver transplantation (OLT) group. Sixty-four percent of the OLT group and 86.4% of control patients successfully completed the protocol, with resolved biliary strictures (P = .1) after a median treatment time of 7 months for both groups (P = .96). During mean follow-up times of 20.3 months ± 11.8 (standard deviation) and 13.1 months ± 11.73 for OLT and non-OLT patients (P = .08), respectively, the primary/secondary patency rates were comparable between groups, at 81.25%/87.5% for OLT patients and 89.5%/100% for non-OLT patients (P = .64/P = .2). The mean time to recurrent stricture was 11.2 months ± 11.88.

Conclusions

Percutaneous large-bore catheter treatment of benign, single-site biliary strictures showed a promising rate of stricture resolution, with comparable high primary and secondary patency rates in patients with and without previous OLT.