肝移植术后胆肠吻合口和非吻合口狭窄的内镜治疗计划。

Scheduled endoscopic treatment of biliary anastomotic and nonanastomotic strictures after orthotopic liver transplantation.

机构信息

Interdisciplinary Center of Endoscopy, University Hospital Heidelberg, Heidelberg, Germany.

Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.

出版信息

Gastrointest Endosc. 2023 Jan;97(1):42-49. doi: 10.1016/j.gie.2022.08.034. Epub 2022 Aug 28.

DOI:10.1016/j.gie.2022.08.034

PMID:36041507

Abstract

BACKGROUND AND AIMS

Biliary strictures after liver transplantation are associated with significant morbidity and mortality. Although various endoscopic treatment strategies are available, consensus on a particular strategy is lacking. Moreover, the influence of endoscopic therapy on overall survival has not been studied. This retrospective study aimed to evaluate the impact of scheduled endoscopic dilatation of biliary strictures after orthotopic liver transplantation on therapeutic success, adverse events, and survival.

METHODS

Between 2000 and 2016, patients with post-transplant anastomotic and nonanastomotic strictures were treated with balloon dilatation at defined intervals until morphologic resolution and clinical improvement. The primary clinical endpoint was overall survival, whereas secondary outcomes were technical and sustained clinical success, adverse events, treatment failure, and recurrence.

RESULTS

Overall, 165 patients with a mean follow-up of 8 years were included; anastomotic and nonanastomotic strictures were diagnosed in 110 and 55 patients, respectively. Overall survival was significantly higher in patients with anastomotic strictures than in those with nonanastomotic strictures (median, 17.6 vs 13.9 years; log-rank: P < .05). Sustained clinical success could be achieved significantly more frequently in patients with anastomotic strictures (79.1% vs 54.5%, P < .001), and such patients showed significantly superior overall survival (19.7 vs 7.7 years; log-rank: P < .001). Sustained clinical success and the presence of nonanastomotic strictures were independently associated with better and worse outcomes (P < .05), respectively.

CONCLUSIONS

Scheduled endoscopic treatment of biliary anastomotic and nonanastomotic strictures after liver transplantation is effective and safe, with high success rates. The implementation of this strategy controls symptoms and significantly improves survival.

摘要

背景与目的

肝移植后出现胆管狭窄会导致较高的发病率和死亡率。尽管有多种内镜治疗策略可供选择，但对于特定策略尚未达成共识。此外，内镜治疗对总生存的影响尚未得到研究。本回顾性研究旨在评估肝移植后胆道吻合口和非吻合口狭窄的定期内镜扩张对治疗成功、不良事件和生存的影响。

方法

在 2000 年至 2016 年间，对移植后吻合口和非吻合口狭窄的患者采用球囊扩张治疗，在形态学缓解和临床改善的情况下，在规定的时间间隔内进行治疗。主要临床终点是总生存，次要终点是技术和持续临床成功、不良事件、治疗失败和复发。

结果

共有 165 例患者被纳入研究，平均随访 8 年；诊断为吻合口狭窄和非吻合口狭窄的患者分别为 110 例和 55 例。吻合口狭窄患者的总生存明显高于非吻合口狭窄患者（中位时间，17.6 年 vs 13.9 年；对数秩检验：P<.05）。吻合口狭窄患者的持续临床成功可显著更频繁地获得（79.1% vs 54.5%，P<.001），且此类患者的总生存明显更优（19.7 年 vs 7.7 年；对数秩检验：P<.001）。持续临床成功和非吻合口狭窄的存在分别与更好和更差的结局相关（P<.05）。