Su1657 Endoscopic Parameters and Clinical Factors Impacting the Success of ERCP in Resolution of Biliary Anastomotic Strictures in Patients After Liver Transplantation

Su1657 Endoscopic Parameters and Clinical Factors Impacting the Success of ERCP in Resolution of Biliary Anastomotic Strictures in Patients After Liver Transplantation Salvatore Francesco Vadala’ Di Prampero*, Giacomo Faleschini, Milutin M. Bulajic, Loris Mario Zoratti, Maurizio Zilli Gastroenterology and GI Endoscopy, University Hospital of Udine, Udine, Italy; Center for Digestive Endoscopy, Faculty of Medicine, Belgrade University, Belgrade, Serbia Introduction and aims: The most frequent biliary complication following liver transplantation (LT) is biliary anastomotic stricture (BAS). To define possible impacting factors of BAS appearance and resolution we analyzed different epidemiological, clinical and endoscopic features in patients undergoing ERCP. Material and methods: We evaluated 171 consecutive liver transplanted recipients recruited in our Centre from 2004 to 2010 (133 males, median age 56 years), with at least one year of follow-up. All patients with clinical or radiologic suspicion of obstructive jaundice and cholestasis underwent ERCP. The concept of ERCP was based on biliary sphyncterotomy followed by stricture dilation and placement of at least one plastic stent, exchangeable every 3-6 months until the final stricture resolution. There have been examined clinical and endoscopic risk factors predicting the success or failure of endoscopic treatment (ERCP). Results: During post-operative follow-up 40 patients presented BAS. The median number of ERCP per patient was 3, median number of stents inserted per patient per procedure was 1 and median period until stricture resolution was 9 months. Stricture resolution was obtained in 83%. Occurrence of BAS was strongly associated with use of Kehr T tube (12/23 Vs 28/148, p!0.01) and with use of cyclosporine as immunosuppressive therapy (18/54 Vs 22/ 117, p!0.05). Independent predictors of BAS development at logistic regression analysis were use of Kehr T tube (O. R. 5.46, p!0.01) and donor male gender (O. R. 2.61, p!0.01). The univariate logistic analysis showed that elevated number of repeated ERCP (OR 0,659; 95% CI 0,522-0,832; pZ0,000), combined stenting with dilation (OR 0,197; 95% CI 0,074-0,525; pZ0,001), increasing number of inserted stents per procedure (OR 0,896; 95% CI 0,782-1,026; pZ0,112) and longer period of warm ischemia (OR 0,966; 95% CI 0,938-0,995; pZ0,023) were associated with successful endoscopic treatment. On the contrary, longer period of stent in place (OR 1,034; 95% CI 1,005-1,064; pZ0,021), elevated MELD score (OR 1,104; 95% CI 1,035-1,178; pZ0,003), elevated Child-Pugh score (OR 1,679; 95% CI 1,089-2,591; pZ0,019) and high pre-transplantation bilirubin values (OR 1,104; 95% CI 1,0071,210; pZ0,035) were associated with endoscopic treatment failure. Conclusions: Endoscopic treatment of BAS requires detailed clinical assessment and skilled equipe. Understanding clinical and endoscopic risk factors may help in predicting of more appropriate regimen of treatment of patients undergoing ERCP for BAS post-LT.