Biliary Complications - The “Achilles Heel” of Orthotopic Liver Transplantation

tive in the treatment of the majority off biliary complications after OLT with a lower complication rate and shorter hospital stay when compared with surgery, and not compromising the option of operation in case of failure [1] . However, in some cases ERCP might not result in a definitive treatment, and long-term follow-up data on outcomes and complications after ERCP in liver transplant patients is scarce [2] . In refractory or unsuccessful ERCP, a percutaneous approach or surgical treatment may be necessary. Biliary complications after OLT include anastomotic strictures (AS), non-anastomotic strictures (NAS), bile duct stones (BDS), biliary leaks (BL) and other less common conditions. ERCP is the first-line treatment modality in the management of biliary complications and is successful in the majority of patients, with PTC reserved for situation in which ERCP is not successful. Management of biliary strictures constitutes the most challenging procedure for the endoscopist, and the optimal management has not been defined. AS are usually short segmental areas of stenosis involving the ductal anastomosis, occur early, and are characterized by the formation of scar tissue at the anastomotic site. Technical problems are the most frequent cause of AS, which comprise up to 85% of biliary strictures diag