Utility of Imaging in Predicting Biliary Strictures Post Liver Transplant

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Post liver transplant biliary strictures are a common complication following orthotropic liver transplantation. ERCP with stenting is the standard of care for management of these strictures. However, ERCP carries risks of infection, bleeding and pancreatitis. Therefore, confirming strictures on imaging can prevent unnecessary procedures. We aimed to assess the accuracy of MRI/MRCP and CT prior to ERCP in predicting biliary strictures. Methods: All patients who had ERCP post-transplant for biliary strictures were included in the study from 2015-2022. We then retrospectively assessed whether they had MRI/MRCP or CT prior to ERCP to look for a biliary stricture. If imaging was obtained, we assessed whether it was suspicious for biliary stricture as characterized by focal narrowing and upstream biliary dilation. We assessed the factors that were associated with either a positive or a negative image prior to ERCP. Results: Eighty-nine patients were confirmed to have a post-transplant anastomotic biliary stricture on ERCP during this time. The mean age of the population was 59.74 +/- 10.8 years. Thirty-3 (37.1%) were female and 73% were White 73%. Median days post-transplant for initial ERCP was 68 (IQR 30-175). Stenting was done for 98.9% of the patients. Initial stenting was done by plastic stents in 91.0%. There was documented removal of stone and sludge in 64.0% of the cases. Main complications encountered were post ERCP pancreatitis in 5.6% and cholangitis 4.5%. MRCP was done prior to ERCP in 44 (49.4%) of cases and it was definitive for a stricture in 33 cases (75%). CT was done prior to ERCP in 27 (30.3%) of cases. It was definitive for a stricture in 9 patients (33.3%). 83 (93.3) had recurrent strictures after initial ERCP requiring further stenting. Median number of procedures following initial stenting was 1 (Range 1-7). Patients who had MRCP diagnostic for stricture had the test done further from transplant median 110 (IQR 47-221) days, compared median 64 (IQR 30-200) days post transplant in patients who had MRCP negative for a stricture (P=0.09) possibly indicating improved accuracy of MRCP further away from transplant. Conclusion: ERCP with stenting is the standard of care for post-transplant biliary strictures. While CT does not appear to be accurate in diagnosing post-transplant biliary strictures, MRCP prior to ERCP can be a safe and effective noninvasive test to define anatomy and confirm a stricture (Figure Presented).

Volume

119

Issue

10

First Page

S107

Last Page

S108

Find It @ Sladen

Share

COinS