| Revista: | Annals of hepatology |
| Base de datos: | PERIÓDICA |
| Número de sistema: | 000411784 |
| ISSN: | 1665-2681 |
| Autors: | Tabibian, James H1 Girotra, Mohit1 Yeh, Hsin-Chieh2 Singh, Vikesh K1 kolo III, Patrick I.O1 Cameron, Andrew M2 Gurakar, Ahmet1 |
| Institucions: | 1Johns Hopkins School of Medicine, Division of Gastroenterology, Hepatology, and Transplant Hepatology, Baltimore, Maryland. Estados Unidos de América 2Johns Hopkins School of Medicine, Department of Epidemiology, Baltimore, Maryland. Estados Unidos de América |
| Any: | 2015 |
| Període: | May-Jun |
| Volum: | 14 |
| Número: | 3 |
| Paginació: | 340-347 |
| País: | México |
| Idioma: | Inglés |
| Tipo de documento: | Artículo |
| Enfoque: | Analítico, descriptivo |
| Resumen en inglés | Anastomotic biliary strictures (ABS) are a significant clinical problem associated with decreased survival post-liver transplantation (LT). Contributing to the morbidity of ABS is the need for early (i.e. emergent or unplanned) repeat endoscopic retrograde cholangiopancreatographies (ER-ERCPs). Our aim was to determine clinical, operative, and endoscopic predictors of ER-ERCP in patients with ABS. Material and methods. Medical records of 559 patients who underwent LT at our institution from 2000-2012 were retrospectively reviewed for pertinent data. The primary endpoint was need for ER-ERCP. Seventeen potential predictors of ER-ERCP were assessed in bivariate analyses, and those with p < 0.20 were included in multivariate regression models. Results. Fifty-four LT patients developed ABS and underwent a total of 200 ERCPs, of which 40 met criteria for ER-ERCP. Predictors of ER-ERCP in bivariate analyses included balloon dilation within 3 months post-LT and donation after cardiac death (both p < 0.05). Balloon dilation within 3 months post-LT was also associated with shorter ER-ERCP-free survival (p = 0.02). Moreover, a significantly higher proportion (67%) of patients who underwent balloon dilation within 3 months post-LT subsequent experienced ≥ 1 ER-ERCP (p = 0.03), and those who experienced ≥ 1 ER-ERCP had lower stricture resolution rates at the end of endoscopic therapy compared to those who did not (79 vs. 97%, p = 0.02). In multivariate analyses, balloon dilation within 3 months post-LT was the strongest predictor of ER-ERCP (OR 3.8, 95% CI 1.7-8.6, p = 0.001). Conclusions. Balloon dilation of ABS within 3 months post-LT is associated with an increased risk of ER-ERCP, which itself is associated with lower ABS resolution rates. Prospective studies are needed to confirm these findings and their implications for endoscopic management and follow-up of post-LT ABS |
| Disciplines | Medicina |
| Paraules clau: | Cirugía, Gastroenterología, Trasplante de hígado, Complicaciones postoperatorias, Obstrucción biliar, Endoscopia, Dilatación con balón |
| Keyword: | Medicine, Gastroenterology, Surgery, Liver transplantation, Postoperative complications, Biliary obstruction, Endoscopy, Balloon dilation |
| Text complet: | Texto completo (Ver PDF) |
