ENDOSCOPIC MANAGEMENT OF BILIARY STRICTURES AFTER LIVER TRANSPLANTATION

Abstract

Biliary stricture is the most common biliary complication after liver transplantation, significantly influencing patient outcomes if inappropriately managed. These strictures are classified into anastomotic (AS) and non-anastomotic strictures (NAS), with postoperative bile leakage contributing to stricture formation. If a biliary stricture is suspected, cross-sectional imaging, including CT and magnetic resonance cholangiopancreatography, is performed, followed by endoscopic retrograde cholangiopancreatography, which remains the first-line modality for accurate assessment and therapeutic intervention. In Japan, endoscopic management generally involves balloon dilation and biliary stent placement. Although this strategy has shown favorable outcomes in AS, endoscopic treatment can be challenging in NAS or strictures associated with severe bile leakage, which sometimes necessitate surgical reintervention. Effective management of post-transplant biliary strictures requires careful endoscopic therapy tailored to the individual case, with a comprehensive understanding of the biliary anastomotic configuration, underlying etiology of the stricture, and biliary anatomy.