ARTICLE IN PRESSfrom the ASGEASGEandards of PracricGUIDELINECommittceAmerican Society for Gastrointestinal Endoscopy guideline onmanagement of post-liver transplant biliary strictures:summary and recommendationsPrepared by Divyanshoo R.Kohli,MD,*Stuart K.Amateau,MD,PhD,FASGE,2*Madhav Desai,MD,MPH,3Srinath Chinnakotla,MD,"M.Edwyn Harrison,MD,>Jean M.Chalhoub,MD,Nayantara Coelho-Prabhu,MD,FASGE,7 Sherif E.Elhanafi,MD,8 Nauzer Forbes,MD,MSc,FASGE,Larissa L.Fujii-Lau,MD,10 Richard S.Kwon,MD,1 Jorge D.Machicado,MD,MPH,11 Neil B.Marya,MD,12Swati Pawa,MD,FASGE,13 Wenly Ruan,MD,14 Sunil G.Sheth,MD,FASGE,15Nikhil R.Thiruvengadam,MD,16 Nirav C.Thosani,MD,17 Bashar J.Qumseya,MD,MPH,FASGE18(ASGE Standards of Practice Committee Chair)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 wasdeveloped using the Grading of Recommendations Assessment,Development and Evaluation framework.Theguideline addresses the role of Endoscopic retrograde cholangiopancreatography (ERCP)versus percutaneoustranshepatic biliary drainage and covered self-expandable metal stents (cSEMSs)versus multiple plastic stentsfor therapy of post-transplant strictures,use of Magnetic Resonance Cholangiopancreatography (MRCP)for diag-nosing post-transplant biliary strictures,and administration of antibiotics versus no antibiotics during ERCP.Inpatients with post-transplant biliary strictures,we suggest ERCP as the initial intervention and cSEMSs as thepreferred stent for extrahepatic strictures.In patients with unclear diagnoses or intermediate probability of a stric-ture,we suggest MRCP as the diagnostic modality.We suggest that antibiotics should be administered duringERCP when biliary drainage cannot be ensured.(Gastrointest Endosc 2022;:1-8.)Tbis guideline document was prepared by the Stan-Bile duct strictures are a common adverse outcome ofdards of Practice Committee of tbe American Society forliver transplantation and are associated with significantGastrointestinal Endoscopy using the best available scien-morbidity.These strictures,and the associated cholangiop-tific evidence and considering a multitude of variablesathy,can lead to a variety of adverse outcomes rangingincluding but not limited to adverse events,patients'from asymptomatic elevation in liver-associated enzymesvalues,and cost implications.Tbe purpose oftbese guide-to hospitalization,cholangitis,allograft rejection,and allo-lines is to provide the best practice recommendations thatgraft failure.2 These post-transplant biliary strictures canmay belp standardize patient care,improve patient out-often be diagnosed based on a varying combination ofcomes,and reduce variability in practice.elevated liver enzymes,conjugated hyperbi lirubinemia,We recognize that clinical decision-making is com-and biliary dilation on imaging.3plex.Guidelines,tberefore,are not a substitute f
