Endoscopic treatment in biliary strictures after pediatric liver transplantation

Background and aim The aim of the study was to assess efficacy and safety of endoscopic treatment in BS after pediatric LTx. Methods We retrospectively reviewed data of patients with DDA who developed BS and underwent ERCP. Results Of 189 transplanted patients with DDA, strictures developed in 30 (16%). In this subgroup, the median age at LTx was 14.7 (1.5‐17.6) and follow‐up period was 3.9 (1.3‐11.3). ABS were in 76% and NABS in combination with ABS in 24% of patients. Overall, 95 ERCP sessions (3.0 per patient) were performed with successful outcome in 22 (73%) cases. Duration of treatment was 9.1 (1.8‐24.1) months. Five patients underwent surgical revision and three patients retransplantation (10%). Risk factors of endoscopy failure were HCV or HBV infection, prolonged CIT and treatment before 2007. The most common complications after ERCP were cholangitis (8.2%) and pancreatitis (4.2%). There were worse overall prognosis and higher risk of post–ERCP complications in NABS. Conclusions ERCP is safe and effective in the majority of patients with post‐transplant duct‐to‐duct BS, and it is currently recommended as the first‐line treatment.