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Titolo:
Establishing a systematic endoscopic approach to the management of anastomotic biliary strictures is needed
Autore:
Baron, TH;
Indirizzi:
Mayo Med Ctr, Dept Gastroenterol & Hepatol, Rochester, MN 55905 USA Mayo Med Ctr Rochester MN USA 55905 ol & Hepatol, Rochester, MN 55905 USA
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 4, volume: 7, anno: 2001,
pagine: 378 - 379
SICI:
1527-6465(200104)7:4<378:EASEAT>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
ORTHOTOPIC LIVER-TRANSPLANTATION; TRACT COMPLICATIONS; EFFICACY; THERAPY;
Tipo documento:
Editorial Material
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
7
Recensione:
Indirizzi per estratti:
Indirizzo: Baron, TH Mayo Med Ctr, Dept Gastroenterol & Hepatol, 200 1st St SW,Eisenberg 8A, Rochester, MN 55905 USA Mayo Med Ctr 200 1st St SW,Eisenberg 8A Rochester MN USA 55905 A
Citazione:
T.H. Baron, "Establishing a systematic endoscopic approach to the management of anastomotic biliary strictures is needed", LIVER TRANS, 7(4), 2001, pp. 378-379

Abstract

Barkground and Study Aims: Anastomotic biliary strictures are the most common cause of biliary obstruction following liver transplantation. We studied the efficacy and safety of endoscopic management of anastomotic strictures retrospectively. Patients and Methods: A stricture at choledocho-choledochal anastomosis was identified in 30 of 354 sequential adult liver-transplant recipients at our institution. Balloon dilation was performed in 29 patients and a stent was inserted across the anastomotic stricture in one patient at initial endoscopy. A total of nine patients did not require further treatment; ten had repeated dilation (median 2). A stent was placed for persistent anastomotic stricture in six patients and for other indications in four patients. Outcomes studied mere improvement in cholestasis, stricture diameter, and need for surgical treatment. Safety of therapy was assessed with nature and number of procedural complications. Results: The median serumbilirubin level decreased from 3.25 mg/dL to 1.1 mg/dL (P<0.001) and median alkaline phosphatase decreased from 451.5 IU/l to 125 IU/l (P=0.001) following endoscopic therapy. Cholestasis improved in 26 of 30 patients with therapy. Of the remainder, three of three patients with concurrent nonanastomotic strictures and one patient with anastomotic stricture and histologic evidence of rejection showed worsening cholestasis at follow-up. Stricture diameter improved from a median of 2.5 mm to 7 mm (P<0.001). Median follow-up was 17.9 months from the last therapeutic endoscopy. Five treatable, nonlethal complications occurred after 77 procedures. None of the patients required surgery for anastomotic stricture during a follow-up period up to 58 months. Conclusions: Endoscopic management offers effective and safe treatment for posttransplantation anastomotic biliary strictures and avoids the need for surgical intervention.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 23/01/20 alle ore 04:26:36