诊断与治疗性胰胆管造影在胆管损伤中的临床应用

目的探讨胰胆管引流（ERCP）在胆管损伤诊断中的作用及其临床应用疗效。方法总结1999年3月至2004年3月收治的31例胆管损伤患者，行诊断性ERCP，选择有内镜治疗价值者作为实施对象，行乳头肌切开术（EST）、鼻胆管引流、塑料支架支撑引流等内镜治疗。结果31例胆管损伤中，胆总管横断或结扎3例，胆管狭窄13例，胆瘘15例，22例（34次）接受内镜治疗，占71％。13例胆管狭窄中，有7例行塑料支架支撑治疗维持8～20个月，4例疗效满意，3例疗效欠佳；15例胆瘘患者行EST、鼻胆管引流，13例胆瘘愈合，2例无效，其中7例因胆管狭窄或有狭窄倾向置入塑料支架支撑维持4～12个月。6例发生术后高淀粉酶血症。结论ERCP对胆管损伤有定性和定位诊断意义，多数胆瘘和部分胆管狭窄患者通过内镜治疗获得痊愈，早期内镜治疗可简化治疗方案，避免再次手术。     

内镜治疗术后胆漏和继发胆管狭窄

目的 探讨内镜治疗手术后并发胆漏和继发胆管狭窄的方法及效果。方法 胆漏患 者均先行内镜下十二指肠乳头切开,行鼻胆管引流术,继续保留原有胆道、腹腔引流。待胆道、腹腔引 流停止1-2周证实胆漏愈合后拔管,伴有胆道狭窄的患者在拔除鼻胆引流管后置入塑料内支架,持 续扩张2-3个月。结果 22例胆漏患者鼻胆引流3-4周后胆漏处均闭合,13例胆管狭窄置入内支 架者,10例支架取出后狭窄解除,2例合并肝总管狭窄者经重新置入双支架3个月后效果良好,1例 左肝管狭窄伴结石者,再置入单支架,术后仍有胆道感染症状反复出现。结论 内镜治疗可列为手术 后胆漏或继发胆管狭窄治疗的首选方法。     

可回收金属支架在胆管良性狭窄中应用配合方法探讨

随着内镜附件及内镜技术的不断发展,内镜下放置胆道金属支架姑息性治疗胆胰管恶性狭窄已是目前较为成熟的治疗方法。但对于胆管良性狭窄患者而言处理起来相对较为棘手,传统的治疗方法为外科手术或经皮肝内球囊扩张胆管狭窄。外科手术并发症多、风险大。经皮肝球囊扩张成功率低、复发率高。而内镜下气囊扩张狭窄胆管及置入支架是目前治疗胆管良性狭窄首选方法。我科2010年1月开始将可回收金属支架应用于肝外胆管良性狭窄患者,得到较好的治疗效果,现将可回收胆道金属支架应用时一些操作配合方法报告如下。     

腹腔镜单纯胆囊切除术后胆道并发症的内镜治疗

目的探讨十二指肠镜治疗腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）后胆道并发症的效果。方法胆管结石先行内镜下胆总管Oddi括约肌切开术（endoscopic sphincterotomy,EST）或内镜下乳头气囊扩张术（endosco picpapillary balloon dilatation,EPBD）后取石,胆总管上段狭窄行胆道扩张加支架置入术,胆漏、胆管横断者行内镜下鼻胆管引流术（endoscopic nasobiliary drainage,ENBD）或内镜下胆管内塑料支架引流术（endoscopic retrograde biliary drainage,ERBD）治疗。结果69例中,胆总管结石53例（76.7%）,胆总管上段部分狭窄11例（15.9%）,胆管横断2例（2.9%）,胆漏3例（4.3%）。53例胆总管结石患者49例行EST后取石,4例因乳头较小行EPBD后取石。11例胆总管部分狭窄行胆道扩张术后放置内支架引流治疗,3个月后5例拔管造影未见明显狭窄结束治疗,6例狭窄未能完全解除者,再行胆管扩张及重新放置塑料内支架,均于9个月内恢复。2例胆管横断患者行ENBD后开腹手术治疗。3例胆漏患者用医用胶注射封堵漏口后行ENBD或ERBD后症状明显减轻,一周后缓解。结论LC后胆道并发症应早期行ERCP以明确诊断;十二指肠镜对LC后并发症的处理是一种好方法,优于其它检查和治疗。     

胆胰管良恶性梗阻的双支架联合引流

目的 探讨胆、胰管良恶性狭窄或梗阻时内镜双支架联合引流的操作技术及其临床疗效。方法 所有患者先行经内镜逆行胰胆管造影，了解胆、胰管狭窄或梗阻的部位、程度，并确定置入支架的外径及长度；然后胆、胰管分别置入导丝，并在导丝引导下按常规分别置入胆管和胰管引流支架。术后观察血清淀粉酶变化及黄疸、腹痛、腹泻等临床症状的改善情况。结果 14例胆、胰管并存狭窄或梗阻患者（壶腹癌5例、胰头癌4例、乳头部癌3例及胰头部慢性炎症2例）均一次操作成功，置入胆管塑料支架14根（12例1根，1例2根），置入金属支架1根；同时还置入胰管支架14根。术后2周、1个月及3个月黄疸消失率分别为50．0％、71．0％和93．0％，术后2周上腹痛缓解率为75．0％；7例腹泻患者，术后1个月5例症状消失，2例明显减轻。未发生与操作相关的早期并发症，术后3个月未发现支架移位及阻塞情况。结论 胆、胰管良恶性狭窄患者经内镜双支架联合引流是一种简便、安全、有效的治疗方法，既能解除黄疸，又能减压止痛，改善胰腺外分泌功能。     

28例次活体肝移植术后胆道并发症的内镜诊疗体会

目的 回顾性分析活体肝移植术后胆道并发症的临床特点,探讨内镜处置相关问题的有效方式.方法 21例活体肝移植胆道并发症患者接受ERCP诊疗,根据胆道造影所见给予相应治疗,观察内镜治疗的效果.结果 21例患者中43.8%处于术后早期,共接受28次内镜诊疗,其中发现胆管吻合口狭窄19例(90.4%),目.多数存在成角畸形;发现吻合口胆漏9例(42.9%).内镜治疗的操作成功率为85.7%,包括鼻胆管引流5例次、单支架引流10例次、气囊扩张和(或)多支架支撑9例次、胆漏腔引流2例次.随访中3例胆漏患者经治疗漏门已愈合,2例吻合口狭窄已基本消除.结论 活体肝移植术后胆道并发症发生率高且上发生早,吻合口严重狭窄伴成角畸形多见,合并胆漏的发生率较高;采用"先治漏,后治窄"的原则进行内镜治疗可取得满意的疗效.     

跨越十二指肠主乳头平行放置双侧金属支架治疗肝门部胆管恶性狭窄的临床研究（含视频）

目的探讨内镜下跨越十二指肠主乳头平行放置双侧胆管金属支架治疗肝门部胆管恶性狭窄的成功率和疗效。方法回顾性纳入2012年1月—2018年12月在上海东方肝胆外科医院内镜中心采用改良内镜引流技术（内镜下跨越十二指肠主乳头平行放置双侧金属支架）治疗的肝门部胆管恶性狭窄（Bismuth Ⅱ~Ⅳ型）患者共55例,分析技术成功率、临床成功率、并发症发生率、内镜下双侧胆管再干预成功率、支架通畅期和生存时间。结果内镜下跨越十二指肠主乳头平行放置双侧金属支架技术成功率为96.4%（53/55）,临床成功率为96.2%（51/53）,早期并发症发生率为13.2%（7/53）,支架中位通畅期为9.2个月（95%CI：8.0~10.3个月）,双侧胆道系统的内镜再干预成功率为92.3%（12/13）,患者的中位生存时间为6.7个月（95%CI：4.7~8.8个月）。结论改良的双侧金属支架置入法治疗无法手术的肝门部胆管恶性狭窄是安全和有效的。     

外放射对中晚期食管癌支架治疗的影响

目的 探讨外放射对中晚期食管癌支架治疗的影响。方法 73例不能切除或拒绝手术治疗的中晚期食客癌合并严重狭窄患者分为两组,A组患者先行内镜支架扩张,术后辅以腔内放疗和热疗,B组患者先接受6000-7000rad的外放射治疗,3-6个月后行内镜下的支架扩张与腔内放射和热疗。结果 A组42例,支架均一次顺利成功置入,成功率为100%,术后并发症少。B组31例支架置入成功率为29%。术后并发症发生率高,包括术后大出血,持续严重胸痛,食管气管漏,支架扩张不良和支架移位再狭窄。结论 外放射治疗明显降低食管癌患者支架置入的成功率,术后并发症更多见更严重。     

肝移植术后胆管并发症的内镜治疗价值

目的评估肝移植术后胆管并发症内镜治疗的临床价值。方法我院从2001年3月至2006年10月进行的45例肝移植中,术后出现胆管并发症16例,其中胆漏1例,胆管狭窄8例,胆管狭窄并胆管结石2例。11例接受了内镜介入治疗计14次,包括内镜下放置鼻胆管外引流4例,放置支架内引流10例,气囊扩张10例,乳头括约肌小切开7例,乳头括约肌切开加取石2例。结果1例因内镜治疗时导丝无法通过狭窄段,改行PTC放置胆管支架,其余胆管并发症经内镜介入治疗有效。结论ERCP有助于肝移植术后胆管并发症诊断,治疗有效、安全,是肝移植术后胆管并发症首选治疗方法。     

恶性梗阻性黄疸内镜下逆行胰胆管造影引流术后疗效观察

目的探讨恶性梗阻性黄疸经内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)引流术后的疗效。方法 60例恶性肿瘤引起的梗阻性黄疸患者,通过ERCP术置入胆管支架,观察插管成功率、肝功能变化及并发症发生情况。结果 60例患者中57例插管成功,成功率为95.0%(57/60)。57例插管成功的患者中9例胆管内放置金属支架,2例行单纯鼻胆管引流,3例行塑料内支架+鼻胆管引流,其余43例行8.5~10F塑料内支架引流术。术后患者黄疸及皮肤瘙痒等表现减轻或消失。术后1周,患者丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)、血清总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(ALP)、r-谷氨酰基转移酶(GGT)均显著降低(P0.05)。9例行胆管金属支架置入的患者中,1例于术后5个月发生支架阻塞,行胆泥清理并置入塑料支架后金属支架引流通畅。1例单纯鼻胆管引流患者20 d后获得外科手术治疗机会,另1例经鼻胆管引流1个月后肝功能恢复正常,得以行外科根治性手术治疗,43例行胆管塑料支架置入的患者中,8例于术后1~4周出现TBIL水平再次上升,行ERCP检查明确为支架移位或阻塞,给予更换支架,其中有1例更换为金属支架,3例置入塑料双支架。结论通过ERCP术放置胆管引流治疗恶性梗阻性黄疸,对于患者黄疸等症状的改善及生存质量的提高具有确切疗效。     

Rapid-sequence endoscopic management of posttransplant anastomotic biliary strictures

BACKGROUND: Post-liver-transplant anastomotic biliary strictures generally have been managed through ERCP with gradual balloon dilation and placement of multiple stents over an extended period of time. OBJECTIVE: Our purpose was to evaluate the long-term outcome of rapid sequence dilation and to shorten the duration of stenting as a therapy for anastomotic biliary strictures. DESIGN: Prospective case series. SETTING: Academic tertiary referral center. INTERVENTIONS: ERCP with rapid-sequence balloon dilation of post-liver-transplant anastomotic biliary strictures followed by stenting with multiple stents over a short time period. MAIN OUTCOME MEASUREMENT: Long-term anastomotic stricture resolution. RESULTS: Thirty-eight patients were prospectively enrolled into a standardized ERCP treatment protocol. The mean number of ERCPs per patient was 3.4 (range 2-6), the mean number of maximum stents inserted was 2.5 (range 1-6), and the mean total stenting period was 107 days (range 20-198 days); the mean follow-up time from completion of the endoscopic therapy was 360 days (range 140-1347 days). Long-term stricture resolution was achieved in 33 of the 38 (87%) patients. LIMITATIONS: Lack of control group, relatively small patient population. CONCLUSIONS: Accelerated dilation and shorter total length of stenting leads to long-term success in the majority of patients with post-liver-transplant anastomotic biliary strictures.     

Endoscopic treatment of sphincterotomy-associated distal common bile duct strictures by using sequential insertion of multiple plastic stents

BACKGROUND: A rare, late complication of endoscopic biliary sphincterotomy is the occurrence of short strictures extending from the papillary orifice to the distal parts of the extraduodenal common bile duct. METHODS: We evaluated the efficacy of the sequential insertion of multiple stents in the treatment of endoscopic biliary sphincterotomy associated common bile duct strictures. The design of the study is a prospective, single-arm observational study at a university-affiliated teaching hospital of 20 patients with distal common bile duct strictures because of choledocholithiasis-related endoscopic biliary sphincterotomy. Endoscopic treatment consisted of the sequential insertion of an increasing number of plastic stents with ever-larger diameters in 3-month follow-up intervals until stricture resolution. The primary outcome of the study was the rate of resolution of the stricture. The parameters measured were the duration of placement of stents, the maximum diameter, the total number of stents, and the total number of endoscopic sessions required for dilation of the strictures. RESULTS: After a median of 9.0 months of stent placement (range 3-22 months) and a median of 20F maximum stent diameter (range 10F-30F), 18 patients (90%) remained stent-free for a median of 14.5 months (range 6-38 months). Two patients (10%) had stricture recurrences at 10 and 24 months. Multivariate regression analysis demonstrated that the time elapsed after endoscopic biliary sphincterotomy was significantly associated with the stent-placement time (however, significance was removed by correction for multiple testing) and the number of ERCPs required for dilation. The initial common bile duct size was significantly associated with the total stent number and diameter needed for stricture resolution (however, significance was removed by correction for multiple testing). Limitations are the low case number and the single-arm, noncontrolled study design. CONCLUSIONS: Sequential insertion of an increasing number of biliary stents affords effective treatment of the distal biliary strictures that develop as a late complication of endoscopic biliary sphincterotomy.     

Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation

BACKGROUND: Optimal therapy for anastomotic biliary strictures occurring after orthotopic liver transplantation (OLT) remains to be defined. We reviewed our experience with endoscopic therapy for such strictures and contrasted it with reported data. METHODS: Endoscopic therapy was performed with balloon dilation alone; no patients received an endoprosthesis. Responses were characterized as good if the patient improved clinically and no subsequent procedures were required after one or more dilations within a 3-month period; partial if clinically significant obstruction resolved but cholestasis persisted or there was a need for further endoscopic management beyond the initial 3 months; poor if subsequent surgery or percutaneous procedures were required; and failed if endoscopic access or dilation could not be accomplished. RESULTS: Fifteen patients underwent 23 endoscopic retrograde cholangiopancreatographies for post-OLT anastomotic strictures. Postprocedure follow-up averaged 25.2 months. Cholangiography was successful in all 23 procedures; free duct access was achieved in 22 of 23 procedures. The strictures were successfully accessed for dilation in 11 of 15 patients and in 19 of 23 procedures. Outcome was deemed good in 4 (27%), partial in 3 (20%), and poor in 5 (33%) patients. Endoscopic therapy failed in 3 (20%). Poor outcomes were due to the early recognition of severe lesions (2 treated surgically) or to short-term responses to dilation alone (3). The procedural complication rate of 17.4% included 3 episodes of transient cholangitis (i.e., elevation of liver enzymes associated with fever that lasted less than 3 days) and 1 self-limited episode of postsphincterotomy bleeding, which required the transfusion of 2 units packed red blood cells. In published series the combined success rate of balloon dilation alone for treatment of anastomotic strictures is 41%, whereas for dilation plus stent placement it is 75%. CONCLUSION: Endoscopic balloon dilation alone is not a reliable method of therapy for anastomotic strictures occurring after OLT. Dilation followed by short- to intermediate-term stent placement appears to provide a more durable result.     

Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy

BACKGROUND: The optimal endoscopic treatment for anastomotic biliary strictures after deceased donor liver transplantation is undefined. Endoscopic therapy with conventional methods of biliary dilation and stent placement has been successful but often requires prolonged therapy. OBJECTIVE: To determine the outcomes of an aggressive endoscopic approach that uses endoscopic dilation followed by maximal stent placement. SETTING: Tertiary-care academic medical center. PATIENTS: Of 176 patients who underwent deceased donor liver transplantation between June 1999 and July 2004, 25 were diagnosed with anastomotic biliary strictures. INTERVENTIONS: Patients were treated endoscopically with a combined technique of balloon dilation and maximal stent placement. MAIN OUTCOME MEASUREMENTS: Treatment outcomes, including bile-duct patency, a need for surgical intervention, morbidity, and mortality, were evaluated retrospectively. RESULTS: Endoscopic dilation followed by maximal stent placement was performed until resolution of strictures in 22 of 25 patients (88% immediate success on intent-to-treat analysis). Persistent resolution of strictures was achieved in 18 of these 22 patients. Re-treatment was successful in 2 of 4 patients with recurrent strictures. Overall, 20 of 22 patients who completed endoscopic therapy (91%) avoided surgical intervention. Median duration of endoscopic treatment was 4.6 months. Patients with early onset strictures required a significantly shorter duration of endoscopic therapy (3 vs 9 months; P<.01). Multiple stent placement was not technically difficult, and no major complications were encountered. CONCLUSIONS: Aggressive endoscopic therapy with combined biliary dilation and maximal stent placement allows resolution of anastomotic biliary strictures after deceased donor liver transplantation in a relatively short period, with sustained success and minimal complications.     

ENDOSCOPIC TREATMENT FOR THE BENIGN BILIARY STRICTURE IN THE PATIENT WITH CHRONIC PANCREATITIS

In some patients with chronic pancreatitis (CP), strictures are observed in the intrapancreatic bile ducts due to fibrosis and inflammation in the pancreas. Normally, even when biliary strictures exist, obstructive jaundice is rarely observed. It seemed that obstructive jaundice was brought about by temporary pancreatitis due to immoderate alcohol ingestion, followed by the aggravation of the intrapancreatic biliary stricture. When immoderate alcohol ingestion is incriminated for the pancreatic disorder, the patient should be strictly instructed to abstain from alcohol, but failure to observe this instruction seems to render endoscopic biliary stenting ineffective. When CP is complicated with pancreatolithiasis, stone fragmentation using extracorporeal shock wave lithotripsy (ESWL) is effective, and combination with endoscopic lithotomy makes it possible to remove pancreatic stones in the main pancreatic duct (MPD). To treat the beside dilating stricture of the MPD, balloon dilation and pancreatic duct stenting are performed. We obtained good results with 10 Fr pancreatic duct stents, but biliary strictures are better treated with a combination of these methods. When 10 Fr or larger straight biliary stents are used, they may be dislodged or stray if the bile duct is sharply curved. To prevent this accident we have used 10 Fr double layer stents and obtained good results. In patients with benign biliary strictures, stents are temporarily placed and should be removable. Some cases have been reported where Wallstent gave good results in a short period, but the stents were occluded due to hyperplastic proliferation of the biliary epithelium. Metal stents are not considered desirable for benign biliary strictures. Our results seem to support the assumption that benign biliary strictures are improved with 10 Fr or larger biliary stents while exercizing care to keep the patient abstinent from alcohol and performing ESWL and endoscopic treatment for CP.     

Endoscopic stenting for post-transplant biliary stricture: usefulness of a novel removable covered metal stent

Background

Endoscopic management of biliary anastomotic stricture (AS) following liver transplantation (LT) remains challenging. There are no dedicated self-expandable metal stents (SEMS) for this setting.

Methods

A short fully covered SEMS (FCSEMS) with a retrieval suture was designed. Between July 2008 and June 2010, 13 patients with post-LT AS had this FCSEMS placed endoscopically, keeping the whole stent inside the bile duct across the AS with the retriever out of the papilla. The stents were removed by forceps under endoscopy according to a schedule. Technical success, complications, AS resolution and the outcome for the patients were observed.

Results

Placement of the FCSEMS was successful on the first attempt in all patients. One patient with complicated infection did not respond to the stenting therapy and underwent stent retrieval ahead of schedule. Others kept well during stenting for a mean (SD) duration of 5.4 (1.7)?months (range 2?C8) without stent migration. All stents were removed successfully without great difficulty. AS resolution was obtained in all 12 patients, who were closely followed up for a mean (SD) time of 12.1 (8.0)?months (range 1?C26.5) after stent removal. Stricture recurrence occurred in one, who underwent a successful re-intervention with a second FCSEMS. Others remain free from symptoms and have normal liver function up to now.

Conclusions

Endoscopic treatment of post-LT AS using a removable FCSEMS is technically feasible, safe, and effective. This dedicated method may play an increasing role in the future management of benign biliary strictures.     

Medium-term results of endoscopic treatment of common bile duct strictures in chronic calcifying pancreatitis with increasing numbers of stents

OBJECTIVES: The goal of this study was to evaluate our medium-term results on common bile duct stenting with increasing numbers of stents on strictures due to chronic calcifying pancreatitis. BACKGROUND: Common bile duct strictures frequently complicate the course of chronic calcifying pancreatitis. The effectiveness of endoscopic stenting to resolve definitely these strictures is still debated. STUDY: Twenty-nine patients with common bile duct stricture due to chronic calcifying pancreatitis were stented and followed up. Biliary sphincterotomy, dilation of the stricture, and insertion of plastic biliary stents (7.5-10 F) were performed. Patients were scheduled for elective stent changing/restenting at 3-month intervals or any time when it was urgently indicated. Our basic intention was to insert the maximum possible number of stents to reach as large diameter as the stricture allowed. All stents were removed after the disappearance of common bile duct dilatation or left in place in cases of persisting strictures. RESULTS: Eighteen patients (60%) had complete radiologic and serologic recovery after a mean of 21.1 months overall stenting time and had a stent free follow-up period for a mean of 12.1 months without recurrence of stricture. Five patients (16%) still have stents in place after 26 months. Three patients (13%) required surgery. There were 3 deaths (10%): 1 for unrelated cause and 2 with septic shock of biliary origin. CONCLUSIONS: Most chronic calcifying pancreatitis patients with common bile duct strictures respond to the increasing numbers of endoscopic stents, and remain stent free for medium term periods. Less patients (30%) does not benefit of biliary stenting, who are candidates for surgery.     

Use of a modified angioplasty balloon catheter in the dilatation of tight biliary strictures.

Nineteen biliary strictures were dilated using a modified angioplasty balloon catheter to allow insertion of a 10F prosthesis. In each instance biliary strictures were successfully dilated which had previously been too tight to widen with standard endoscopic biliary dilating catheters. Eleven patients had malignant hilar strictures, four malignant distal common bile duct strictures, and four benign strictures. There were no complications as a result of the procedure and satisfactory biliary drainage was established in all patients. We conclude that tight biliary strictures can be successfully dilated using a modified angioplasty balloon catheter.     

Aluminum phosphide-induced esophageal strictures: a new cause of benign esophageal strictures

Fifteen consecutive patients presenting with dysphagia due to aluminum phosphide (AP)-induced esophageal strictures were studied retrospectively to elucidate the natural history of AP-induced esophageal strictures and to evaluate the efficacy of bougie dilation. The median time lag between consumption of AP and occurrence of dysphagia was 3 weeks. All patients had a single stricture and could be dilated using a bougie dilator. Thirteen patients were relieved of dysphagia on a mean (SD) follow-up of 18 (7.3) months. Two patients had recalcitrant strictures and needed needle-knife incision of the stricture followed by balloon dilation. The strictures opened up well in both the patients and they were relieved of dysphagia. AP-induced esophageal stricture is a new cause of benign esophageal stricture. Most patients present with dysphagia around 3 weeks after consumption of AP tablets. A single esophageal stricture is found in these patients. Most strictures respond very well to bougie dilation. However, some of the strictures may be recalcitrant and may require needle-knife incision and balloon dilation.     

Endoscopic management of biliary strictures after liver transplantation

Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation （OLT）. Biliary strictures are classified as anastomotic or non-anastomotic strictures according to location and are defined by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is significant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. Thisreview focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.