American Society for Gastrointestinal Endoscopy guideline on management of post-liver transplant biliary strictures: summary and recommendations

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides an evidence-based approach for strategies to manage biliary strictures in liver transplant recipients. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses the role of ERCP versus percutaneous transhepatic biliary drainage and covered self-expandable metal stents (cSEMSs) versus multiple plastic stents for therapy of post-transplant strictures, use of MRCP for diagnosing post-transplant biliary strictures, and administration of antibiotics versus no antibiotics during ERCP. In patients with post-transplant biliary strictures, we suggest ERCP as the initial intervention and cSEMSs as the preferred stent for extrahepatic strictures. In patients with unclear diagnoses or intermediate probability of a stricture, we suggest MRCP as the diagnostic modality. We suggest that antibiotics should be administered during ERCP when biliary drainage cannot be ensured.

Automated summary

This clinical practice guideline provides evidence-based strategies for managing biliary strictures in liver transplant recipients. The guideline covers the role of different interventions and diagnostic modalities, such as ERCP, percutaneous transhepatic biliary drainage, cSEMSs, multiple plastic stents, and MRCP. It also discusses the administration of antibiotics during ERCP. Recommendations include the use of ERCP as the initial intervention and cSEMSs as the preferred stent for extrahepatic strictures, the use of MRCP for unclear diagnoses or intermediate probability of a stricture, and the administration of antibiotics when biliary drainage cannot be ensured during ERCP.