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Risk factors for early repeat ERCP in liver transplantation patients with anastomotic biliary stricture.
Tabibian, James H; Girotra, Mohit; Yeh, Hsin-Chieh; Singh, Vikesh K; Okolo, Patrick I; Cameron, Andrew M; Gurakar, Ahmet.
Afiliação
  • Tabibian JH; Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
  • Girotra M; Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Yeh HC; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Singh VK; Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Okolo PI; Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Cameron AM; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Gurakar A; Division of Gastroenterology, Hepatology, and Transplant Hepatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Ann Hepatol ; 14(3): 340-7, 2015.
Article em En | MEDLINE | ID: mdl-25864214
INTRODUCTION: 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.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ductos Biliares / Stents / Colestase / Colangiopancreatografia Retrógrada Endoscópica / Transplante de Fígado / Implantação de Prótese Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Ann Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2015 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: México
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ductos Biliares / Stents / Colestase / Colangiopancreatografia Retrógrada Endoscópica / Transplante de Fígado / Implantação de Prótese Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Ann Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2015 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: México