Research Article

Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis

Volume: 52 September 8, 2026
EN TR

Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis

Abstract

Non-anastomotic biliary strictures (NAS) represent one of the most challenging complications after living donor liver transplantation (LDLT) and are associated with heterogeneous outcomes following endoscopic retrograde cholangiopancreatography (ERCP). While ERCP is widely accepted as first-line therapy, the impact of stricture localization on endoscopic treatment success remains insufficiently defined. This study aimed to determine whether stricture location, as defined by the Buis classification, predicts ERCP outcomes in patients with NAS after LDLT. In this retrospective single-center study, LDLT recipients who underwent ERCP for post-transplant biliary strictures between January 2020 and January 2025 were evaluated. Among 124 patients with post-transplant biliary strictures, 44 patients (35.5%) with NAS constituted the study cohort and were analyzed separately from patients with anastomotic strictures (n=80). Pre-procedural magnetic resonance cholangiopancreatography was used to classify NAS according to the Buis classification. ERCP technical success, clinical success, recurrence, complications, and the need for percutaneous or surgical interventions were assessed and compared according to Buis-defined stricture locations. Overall ERCP success rates were significantly lower in patients with NAS compared with anastomotic strictures (63.6% vs. 88.7%, p<0.001). Within the NAS cohort, ERCP success varied markedly according to stricture location. Technical success rates were highest in Buis type 1 strictures (94.4%) and progressively declined in type 2 (74.0%), type 3 (40.0%), and type 4 lesions (33.3%) (p<0.001). Strictures involving intrahepatic regions, particularly C and D zones, were associated with significantly lower sustained clinical success and a higher need for adjunctive percutaneous interventions. Percutaneous guidewire-assisted access or biliary drainage was required in 61.3% of patients with intrahepatic involvement compared with 18.2% in extrahepatic-limited disease (p=0.002). Repeat ERCP sessions were more frequent in complex NAS patterns (median 5 vs. 2 sessions, p=0.004). Post-ERCP cholangitis occurred more commonly in NAS patients with multifocal intrahepatic disease (31.8%), whereas rates of pancreatitis (6.8%), bleeding (4.5%), and perforation (0%) remained low and comparable across locations. Sustained clinical success without recurrence was highest in extrahepatic-limited strictures (81.8%) and lowest in diffuse intrahepatic disease (22.2%). Stricture location is a major determinant of ERCP success in non-anastomotic biliary strictures after LDLT. Buis classification–based pre-procedural assessment provides valuable prognostic information and may guide individualized treatment strategy selection. Early consideration of percutaneous approaches in intrahepatic NAS may improve clinical outcomes, reduce repeated ERCP sessions, and minimize procedure-related complications.

Keywords

References

  1. 1.Campbell WL, Sheng R, Zajko AB, Abu-Elmagd K, Demetris AJ. Intrahepatic biliary strictures after liver transplantation. Radiology. 1994;191:735–740.
  2. 2.Ryu CH, Lee SK. Biliary strictures after liver transplantation. Gut Liver. 2011;5(2):133–142. doi:10.5009/gnl.2011.5.2.133.
  3. 3.Kochhar G, Parungao JM, Hanouneh IA, Parsi MA. Biliary complications following liver transplantation. World JGastroenterol. 2013;19(19):2841–2846. doi:10.3748/wjg.v19.i19.2841.
  4. 4.Boeva I, Karagyozov PI, Tishkov I. Post-liver transplant biliary complications: Current knowledge and therapeutic advances. World J Hepatol. 2021;13(1):66–79. doi:10.4254/wjh.v13.i1.66.
  5. 5.Boeva I, Karagyozov PI, Tishkov I. Post-liver transplant biliary complications: current knowledge and therapeutic advances. World J Hepatol. 2021;13(1):66–79.
  6. 6.Chang JH, Lee I, Choi MG, et al. Current diagnosis and treatment of benign biliary strictures after living donor livertransplantation. World J Gastroenterol. 2016;22:1593–1606.
  7. 7.Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and newchallenges. Am J Transplant. 2013;13(2):253–265. doi:10.1111/ajt.12034
  8. 8.Holt AP, Thorburn D, Mirza D, Gunson B, Wong T, Haydon G.A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation. 2007;84:857–863.

Details

Primary Language

English

Subjects

Gastroenterology and Hepatology

Journal Section

Research Article

Publication Date

September 8, 2026

Submission Date

June 25, 2026

Acceptance Date

August 10, 2026

Published in Issue

Year 2026 Volume: 52

APA
Bas, B., Şahin, H., & Kucukdemırcı, O. (2026). Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis. Journal of Uludağ University Medical Faculty, 52. https://doi.org/10.32708/uutfd.1978706
AMA
1.Bas B, Şahin H, Kucukdemırcı O. Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis. Journal of Uludağ University Medical Faculty. 2026;52. doi:10.32708/uutfd.1978706
Chicago
Bas, Berk, Halil Şahin, and Omer Kucukdemırcı. 2026. “Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis”. Journal of Uludağ University Medical Faculty 52 (September). https://doi.org/10.32708/uutfd.1978706.
EndNote
Bas B, Şahin H, Kucukdemırcı O (September 1, 2026) Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis. Journal of Uludağ University Medical Faculty 52
IEEE
[1]B. Bas, H. Şahin, and O. Kucukdemırcı, “Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis”, Journal of Uludağ University Medical Faculty, vol. 52, Sept. 2026, doi: 10.32708/uutfd.1978706.
ISNAD
Bas, Berk - Şahin, Halil - Kucukdemırcı, Omer. “Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis”. Journal of Uludağ University Medical Faculty 52 (September 1, 2026). https://doi.org/10.32708/uutfd.1978706.
JAMA
1.Bas B, Şahin H, Kucukdemırcı O. Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis. Journal of Uludağ University Medical Faculty. 2026;52. doi:10.32708/uutfd.1978706.
MLA
Bas, Berk, et al. “Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis”. Journal of Uludağ University Medical Faculty, vol. 52, Sept. 2026, doi:10.32708/uutfd.1978706.
Vancouver
1.Berk Bas, Halil Şahin, Omer Kucukdemırcı. Does Stricture Location Predict ERCP Success in Non-Anastomotic Biliary Strictures After Living Donor Liver Transplantation? A Buis-Based Analysis. Journal of Uludağ University Medical Faculty. 2026 Sep. 1;52. doi:10.32708/uutfd.1978706

ISSN: 1300-414X, e-ISSN: 2645-9027

Creative Commons License
Journal of Uludag University Medical Faculty is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
2023