Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 977-981
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.977
Paclitaxel-eluting balloon dilation of biliary anastomotic stricture after liver transplantation
Anna Hüsing, Holger Reinecke, Vito R Cicinnati, Susanne Beckebaum, Christian Wilms, Hartmut H Schmidt, Iyad Kabar
Anna Hüsing, Vito R Cicinnati, Susanne Beckebaum, Christian Wilms, Hartmut H Schmidt, Iyad Kabar, Department of Transplant Medicine, University Hospital Münster, 48149 Münster, Germany
Holger Reinecke, Division of Angiology, Department of Cardiology and Angiology, University Hospital Münster, 48149 Münster, Germany
Author contributions: Hüsing A, Reinecke H, Schmidt HH and Kabar I designed the study; Kabar I, Wilms C and Hüsing A performed the study; Hüsing A, Cicinnati VR, Wilms C, Beckebaum S and Kabar I collected the patient data; Hüsing A, Beckebaum S, Cicinnati VR, Reinecke H and Kabar I analyzed the data; Kabar I, Hüsing A, Cicinnati VR and Schmidt HH wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Iyad Kabar, MD, Department of Transplant Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A14, 48149 Münster, Germany. iyad.kabar@ukmuenster.de
Telephone: +49-251-8344957 Fax: +49-251-8357771
Received: July 8, 2014
Peer-review started: July 9, 2014
First decision: August 15, 2014
Revised: September 2, 2014
Accepted: October 14, 2014
Article in press: October 15, 2014
Published online: January 21, 2015
Abstract

AIM: To investigate the safety and effectiveness of endoscopic therapy with a paclitaxel-eluting balloon (PEB) for biliary anastomotic stricture (AS) after liver transplantation (LT).

METHODS: This prospective pilot study enrolled 13 consecutive eligible patients treated for symptomatic AS after LT at the University Hospital of Münster between January 2011 and March 2014. The patients were treated by endoscopic therapy with a PEB and followed up every 8 wk by endoscopic retrograde cholangiopancreatography (ERCP). In cases of re-stenosis, further balloon dilation with a PEB was performed. Follow-up was continued until 24 mo after the last intervention.

RESULTS: Initial technical feasibility, defined as successful balloon dilation with a PEB during the initial ERCP procedure, was achieved in 100% of cases. Long-term clinical success (LTCS), defined as no need for further endoscopic intervention for at least 24 mo, was achieved in 12 of the 13 patients (92.3%). The mean number of endoscopic interventions required to achieve LTCS was only 1.7 ± 1.1. Treatment failure, defined as the need for definitive alternative treatment, occurred in only one patient, who developed recurrent stenosis with increasing bile duct dilatation that required stent placement.

CONCLUSION: Endoscopic therapy with a PEB is very effective for the treatment of AS after LT, and seems to significantly shorten the overall duration of endoscopic treatment by reducing the number of interventions needed to achieve LTCS.

Keywords: Liver transplantation, Anastomotic stricture, Endoscopic therapy, Endoscopic retrograde cholangiopancreatography, Balloon dilation, Paclitaxel-eluting balloon

Core tip: Biliary anastomotic stricture is common after liver transplantation and can significantly impair both organ and patient survival. Endoscopic treatment of an anastomotic stricture usually requires many interventions before long-term resolution is achieved. This study investigated the safety and efficacy of an innovative approach using endoscopic therapy with a paclitaxel-eluting balloon for the treatment of biliary anastomotic stricture after liver transplantation. Our data are very promising and show excellent long-term results. Furthermore, use of a paclitaxel-eluting balloon seems to reduce the number of endoscopic interventions needed to achieve sustained resolution of the stricture.