Urgent repeat ERCP hints at plastic stent failure
It appears that urgent repeat endoscopic retrograde cholangiopancreatography (ERCP) predicts failure of plastic stent treatment for biliary strictures (BS) following liver transplant, according to a study.
Overall, 31 patients met the inclusion criteria. Of these, 24 (77.4 percent) resolved with plastic stenting and seven needed surgery.
No significant differences were observed between stent responders and nonresponders with respect to demographics, transplant and postoperative hospitalization data, time from transplantation to presentation with stricture, total number of ERCP sessions, or maximal number of stents.
There was a trend toward a difference in the time elapsed between the first and the second ERCP, in which a second procedure was performed among ERCP nonresponders sooner than responders. Patients who underwent the second procedure as scheduled had a 95-percent endoscopic success rate, while those who presented urgently with acute cholangitis had a 55-percent failure rate (p=0.02).
“This finding may assist earlier triage of these patients toward alternative treatment such as metal stents or surgery, thus sparing needless procedures and complications,” the investigators said.
To identify predictors of response or failure of standard, endoscopic treatment, the investigators performed a retrospective review of the Database of Gastroenterology Department at Tel Aviv Medical Center and analysed data regarding patients who underwent liver transplantation and developed BS.
BS is a common complication of liver transplantation, and the standard treatment is sequential insertion of increasing numbers of plastic stents by ERCP. However, despite high success rates, some strictures fail to resolve and require surgery as definitive treatment, according to the investigators.