Rossi A F, Grosso C, Zanasi G, Gambitta P, Bini M, De Carlis L, Rondinara G, Arcidiacono R
Gastroenterology and Digestive Endoscopy Unit, Niguarda Ca'Granda Hospital, Milan, Italy.
Endoscopy. 1998 May;30(4):360-6. doi: 10.1055/s-2007-1001283.
The choledocho-choledochostomy (CCS) stricture is one of the most frequent complications occurring after liver transplantation. Endoscopic retrograde cholangiography (ERCP) is the most sensitive method used to define the presence and narrowness of the stricture. Endoscopic stenting of the strictured anastomosis could provide an effective alternative to the surgical intervention.
ERCP was performed in 36 of 210 patients with liver transplantation and acute cholestasis or jaundice: in 15 cases biliary anastomotic stricture was found. These patients were endoscopically treated by long-term stenting of the common bile duct (CBD) (1 year) and followed up for more than 12 months after stent removal.
In all cases the stenting procedure resolved the biliary obstruction syndrome within 7 days. At the end of the stenting period the CCS was dilated enough to allow adequate bile flow and absence of cholestasis. Moreover, in most patients (10) the anastomosis was kept patient for more than 1 year after stent removal, whereas only two patients had stricture recurrence and needed endoscopic restenting. Four patients dropped out of the study, respectively because of liver rejection (two), acute liver failure (one) and myocardial infarction (one). One patient who developed a stone of the transplanted CBD underwent surgical intervention.
According to our data, the endoscopic stenting of the CBD might be considered as the first choice procedure in the setting of the biliary anastomotic strictures occurring after liver transplantation. It has proved to be safe and effective, avoiding the need for more invasive surgery, which in any case should be considered for nonresponsive patients.
胆总管-胆总管吻合术（CCS）狭窄是肝移植术后最常见的并发症之一。内镜逆行胆管造影（ERCP）是用于确定狭窄的存在和狭窄程度的最敏感方法。对狭窄的吻合口进行内镜支架置入可为手术干预提供一种有效的替代方法。
210例肝移植后出现急性胆汁淤积或黄疸的患者中，36例接受了ERCP检查：其中15例发现了胆肠吻合口狭窄。这些患者通过内镜下对胆总管（CBD）进行长期支架置入（1年）治疗，并在支架取出后随访12个月以上。
所有病例中，支架置入术均在7天内解决了胆道梗阻综合征。在支架置入期结束时，CCS扩张到足以保证胆汁充分流动且无胆汁淤积。此外，大多数患者（10例）在支架取出后吻合口保持通畅超过1年，而只有2例患者出现狭窄复发，需要内镜再次置入支架。4例患者退出研究，分别是因为肝排斥反应（2例）、急性肝衰竭（1例）和心肌梗死（1例）。1例发生移植的CBD结石的患者接受了手术干预。
根据我们的数据，对于肝移植后发生的胆肠吻合口狭窄，CBD内镜支架置入术可被视为首选治疗方法。它已被证明是安全有效的，避免了更具侵入性的手术，对于无反应的患者无论如何都应考虑手术治疗。
