P0048 - Optimal Endoscopic Management of Orthotopic Liver Transplant Anastomotic Strictures

Bishal Paudel, MD¹, Jonathan Smith, ², Matthew Giansiracusa, DO², Apara Agarwal, MD¹, Andrew Kleehammer, DO², Jennifer Fieber, MD², Andreas Zori, MD¹, Christopher Forsmark, MD¹, Aleksey Novikov, MD^2
1University of Florida, Gainesville, FL; ²University of Florida College of Medicine, Gainesville, FL

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a preferred management modality for strictures after orthotopic liver transplantation (OLT); however, there is no consensus on what constitutes the best endoscopic treatment of OLT strictures. In this study, we sought to evaluate outcomes of endoscopic management from our high-volume liver transplant program.

Methods: We conducted a retrospective study of all liver transplants that were performed between January 2019 to December 2022. Follow-up was at least 12 months. Electronic medical record was reviewed for demographic information and procedure details. Comparisons were made using standard statistical methods.

Results: We evaluated 84 patients who underwent ERCP for management. In our study, 24 patients (28.6%) received metal stents, 18 (21.4%) received plastic stents, and 42 (50.0%) had both. Patients treated exclusively with metal stents needed significantly fewer procedures. Analysis showed that patients treated exclusively with metal stents needed 2.91 ERCPs (95% CI: 2.40 to 3.42), compared to 4.63 ERCPs (95% CI: 4.07 to 5.20) in those who were treated with plastic only or with a combination of plastic and metal stents (p< 0.0001). The mean length of stenting for patients treated exclusively with metal stents was 305 days (95% CI: 215 to 394) versus 303 days (95% CI: 234 to 371) for those treated with plastic only or with a combination of plastic and metal stents (p=ns). Patients treated only with metal stents showed a resolution rate of 84.6% (22 out of 24 patients), whereas patients treated with plastic only or with a combination of plastic and metal stents had a resolution rate of 81.7% (49 out of 60 patients) (p=ns). In regard to complications, 84 patients underwent combined 382 ERCP procedures. There were 16 cases of post-ERCP pancreatitis (4.12%). There were 2 post-sphincterotomy bleeds (0.50%).

Discussion: Overall, use of covered self-expanding metal stents resulted in significantly fewer procedures, but the length of stenting to achieve stricture resolution or therapeutic success were not different. Choice of stent type depends on a variety of factors, including location of the stricture, size of the duct, and presence of concomitant bile leak. This data suggests that when feasible, covered metal stent placement is preferred to reduce the number of procedures required to treat these strictures.


Disclosures:


Bishal Paudel, MD¹, Jonathan Smith, ², Matthew Giansiracusa, DO², Apara Agarwal, MD¹, Andrew Kleehammer, DO², Jennifer Fieber, MD², Andreas Zori, MD¹, Christopher Forsmark, MD¹, Aleksey Novikov, MD². P0048 - Optimal Endoscopic Management of Orthotopic Liver Transplant Anastomotic Strictures, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.