To compare the initial success rate, feasibility, and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) versus percutaneous transhepatic cholangiography (PTC) for anastomotic biliary stricture after liver transplantation (LT).

We retrospectively analyzed the data collected during January 2015 to December 2021 from liver transplantation recipients who developed anastomotic biliary stricture after liver transplantation and treated by ERCP and/or PTC. The success rate, complications and patients’ survival rate of ERCP and PTC procedures was evaluated.

Forty-eight patients who underwent LT and were confirmed to have the anastomotic biliary stricture were enrolled. Overall, 48/48 patients underwent single or multiple ERCP procedures as the first line therapy; 121 therapeutic ERCPs (3.36 ± 2.53 ERCPs per patient) were performed in 36/48 patients successfully. All the 12 patients who failed ERCP tend to have special bile duct conditions such as overlong, angle shaped, and/or extremely narrowed bile duct and underwent PTC as an alternative treatment. The initial success rate of ERCP was 75% (36/48) while the success rate of ERCP for the 12 patients with special bile duct was 0% (0/12). PTC was an effective second-line treatment for those 12 patients who failed ERCP, and 58.33% (7 of 12 cases) were treated successfully. The average procedure time in PTC group was significantly lower than ERCP group (t=2.292, P=0.027). The feasibility of ERCP was associated with the anatomical shape of bile duct and the severity of the stricture site. Finally, the cumulative survival rate was 100% (12/12) in PTC group compared to 86.11% (31/36) in ERCP group (χ^{2 =}0.670, P=0.413).

ERCP is the gold standard method for the diagnosis and effective intervention for the management of biliary complications after LT. However, its use in certain types of biliary complications (e.g., patients with severe anastomotic biliary stricture and those with overlong and angle shaped bile ducts) is not promising and associated with significant risk of complications. PTC and other interventions should be studied along with ERCP for patients for whom ERCP may not work. The feasibility and efficacy of primary management can be predicted by the noninvasive imaging examinations like Magnetic Resonance Cholangiopancreatography (MRCP) before the procedure, which may help with the choice of the most reasonable therapeutic modality and avoiding unnecessary financial burden and complications.

比较内镜逆行胰胆管造影 (ERCP) 与经皮经肝胆管造影 (PTC) 治疗肝移植 (LT) 后吻合口胆管狭窄的初始成功率、可行性和有效性。

我们回顾性分析了 2015 年 1 月至 2021 年 12 月从肝移植后出现吻合口胆道狭窄并接受 ERCP 和/或 PTC 治疗的肝移植受者收集的数据。评估ERCP和PTC手术的成功率、并发症和患者生存率。

入组 48 名接受 LT 并被证实患有吻合口胆管狭窄的患者。总体而言，48/48 名患者接受了单次或多次 ERCP 手术作为一线治疗；在 36/48 名患者中成功进行了 121 次治疗性 ERCP（每位患者 3.36 ± 2.53 次 ERCP）。所有 12 名 ERCP 失败的患者都倾向于有特殊的胆管状况，例如胆管过长、角形和/或胆管极度狭窄，因此接受了 PTC 作为替代治疗。ERCP初始成功率为75%（36/48），12例特殊胆管患者ERCP成功率为0%（0/12）。对于 ERCP 失败的 12 例患者，PTC 是一种有效的二线治疗，58.33%（12 例中的 7 例）治疗成功。PTC组平均手术时间明显低于ERCP组（吨=2.292,磷=0.027)。ERCP的可行性与胆管的解剖形状和狭窄部位的严重程度有关。最后，PTC组的累积生存率为100%（12/12），而ERCP组为86.11%（31/36）。χ ^{2 =}0.670,磷=0.413）。

ERCP 是 LT 后胆道并发症诊断和有效干预的金标准方法。然而，它在某些类型的胆道并发症（例如，患有严重吻合口胆管狭窄和胆管过长和呈角形的患者）中的应用前景不佳，并且与并发症的显着风险相关。对于 ERCP 可能不起作用的患者，应与 ERCP 一起研究 PTC 和其他干预措施。术前通过磁共振胰胆管造影（MRCP）等无创影像学检查可以预测初级治疗的可行性和有效性，有助于选择最合理的治疗方式，避免不必要的经济负担和并发症。