Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, USA.
Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Gastrointest Endosc. 2023 Apr;97(4):607-614. doi: 10.1016/j.gie.2022.10.007. Epub 2023 Feb 14.
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides an evidence-based approach for strategies to manage biliary strictures in liver transplant recipients. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses the role of ERCP versus percutaneous transhepatic biliary drainage and covered self-expandable metal stents (cSEMSs) versus multiple plastic stents for therapy of post-transplant strictures, use of MRCP for diagnosing post-transplant biliary strictures, and administration of antibiotics versus no antibiotics during ERCP. In patients with post-transplant biliary strictures, we suggest ERCP as the initial intervention and cSEMSs as the preferred stent for extrahepatic strictures. In patients with unclear diagnoses or intermediate probability of a stricture, we suggest MRCP as the diagnostic modality. We suggest that antibiotics should be administered during ERCP when biliary drainage cannot be ensured.
本临床实践指南由美国胃肠内镜学会制定，为肝移植受者胆管狭窄的管理策略提供了循证方法。本文件采用推荐评估、制定与评估分级框架制定。本指南涉及 ERCP 与经皮经肝胆管引流的作用，以及治疗移植后狭窄时覆盖自膨式金属支架（cSEMS）与多个塑料支架的作用、磁共振胰胆管成像（MRCP）在诊断移植后胆管狭窄中的应用，以及 ERCP 期间使用抗生素与不使用抗生素。对于移植后胆管狭窄患者，我们建议 ERCP 作为初始干预措施，cSEMS 作为首选支架用于治疗肝外胆管狭窄。对于诊断不明确或狭窄可能性为中等的患者，我们建议采用 MRCP 作为诊断方法。当不能保证胆汁引流时，我们建议在 ERCP 期间使用抗生素。
