Endoscopic Treatment of Biliary Anastomotic Strictures After Liver Transplantation: Algorithmic Approach of a Single Tertiary Center.

BACKGROUND

The optimal endoscopic strategy for postliver transplantation anastomotic strictures remains undefined. This study aimed to evaluate an algorithmic, stepwise approach based on stricture severity over a 13-year period.

METHODS

This retrospective study included 78 patients treated between 2011 and 2024. Standard endoscopic passage of the anastomotic stricture using a guidewire was attempted in all cases. When this was unsuccessful, a percutaneous-endoscopic rendezvous procedure was performed; if the stricture remained impassable, a magnetic compression anastomosis was applied.

RESULTS

A total of 613 procedures were performed. The proximal side of the stricture was successfully traversed by standard endoscopy in 55 patients (70.5%), by rendezvous in 15 (19.2%), and by magnetic compression in 8 (10.3%). Stent-free follow-up was achieved in 55 patients (70.5%), with a mean treatment duration of 12.3 months. Recurrence occurred in 10 patients (18.2%), and complications developed in 8.2% of procedures, most commonly stent migration.

CONCLUSION

A structured algorithm incorporating rendezvous and magnetic compression techniques can enhance overall success in complex post-transplant biliary strictures.