Background/Objectives: Data on the natural history and endoscopic treatment outcomes of recurrent anastomotic biliary stricture (RABS) after orthotopic liver transplantation (OLT) are limited. This study aimed to evaluate the incidence and outcomes of RABS after OLT. Methods: A retrospective single-center study on OLT patients who underwent successful endoscopic treatment of ABS was conducted. The incidence of RABS, risk factors for recurrence, and outcomes of repeat endoscopic therapy were recorded. Results: A total of 131 OLT patients with ABS underwent endoscopic treatment, of which 119 successfully completed an endoscopic treatment course. After a median follow-up of 51.5 months (IQR 18.5-86.25) from ABS resolution, 26/119 patients (22.7%) developed RABS. All patients with RABS underwent a second endoscopic treatment course; 24 patients received self-expandable metal stents and 2 received plastic stents. Re-treatment was successful in 21 patients (80.8%) after a median of 8.5 months (IQR 5.25-14.50) and a total of 62 ERCPs. Adverse events occurred in two patients (7.4%)-one bacteremia and one suprastenotic biliary stricture. After a median follow-up of 65.5 months (IQR 20.75-125.5) from stent removal, only one patient had a second recurrence, which was treated with a Roux-en-Y hepaticojejunostomy. Multivariate analysis showed that older age at ABS diagnosis (OR 1.1; 95% CI: 1.1-1.2 p = 0.04) was the only independent risk factor for recurrence. Conclusions: RABS affects more than 20% of patients after successful endoscopic treatment. A second endoscopic therapy with covered self-expandable metal stents is a safe and effective option and should be considered before more invasive options.

Background: Over the last two decades, therapy for benign esophageal strictures has shifted from empirical dilatations and surgery to evidence-based and complex endoscopic and surgical procedures, aiming to achieve long-term esophageal patency. Aim: The purpose of our study is to provide descriptive evidence regarding the appropriate tailored medical, endoscopic, and surgical management of benign esophageal strictures. Methods: This retrospective study includes patients with benign esophageal strictures; the data collected encompass the complete patient profiles, detailed etiologic and anatomic workups of the strictures, comprehensive imaging, as well as management and follow-up details. Technical and clinical success rates, adverse events, stricture patency, and the need for additional therapy have been evaluated. Results: Most of the strictures (80.2%) were complex, requiring advanced techniques for management. The primary treatment involved endoscopic dilation, performed with Savary-Gillard bougie dilators in 76.7% of cases and pneumatic balloon dilators in 23.3% of cases. Clinical success was achieved in 95.3% of patients, with a significant improvement in the Ogilvie dysphagia score. Patients with caustic strictures required repeated dilations over the years, compared to shorter intervals for peptic strictures. Adverse events were minimal (e.g., perforation 2.3% and bleeding 4.7%) and managed predominantly endoscopically. Refractory strictures (16.3%) required advanced interventions, including fully covered self-expandable metallic stents (fc-SEMS) and corticosteroid injections. Conclusions: Both our data and the current literature support the use of tailored endoscopic strategies as the first-choice options for managing benign esophageal strictures. Our results strongly suggest against one-size-fits-all therapeutic alternatives.

Abstract An 11‐year‐old, entire, male dog was presented with symptoms of tenesmus and diagnosed with severe rectal stenosis, which had developed, while the dog was left untreated for perianal fistulas that had persisted for 6 months. A rectal exam revealed a stenotic lesion, which was confirmed by colonoscopy. A computed tomography scan confirmed the presence of severe faecal impaction. Given the existing faecal obstruction, rapid dilation of the stenosis was necessary. The bougienage technique was unsuccessful. Manual laceration of the stenotic tissue was thus performed using both index fingers without complications. An excellent short‐term response was observed, with no recurrence noted 1 year after initiating immunomodulatory treatment. Balloon dilation remains the most frequent intervention for the management of benign rectal strictures. However, manual laceration has not been described previously as a management approach for these strictures. The goal of this article is to describe this novel technique and its safety. The clinical signs, differential diagnoses, diagnostic options and therapeutic approaches for benign rectal stenosis are also discussed.

Biliary strictures (BS) remain a challenge in pediatric liver transplant (LT). Achievement of the "Optimal Biliary Outcome" (OBO), stricture resolution without recurrence or surgery is the goal. We analyzed cost associated with different management. Society of Pediatric LT (SPLIT) data were matched with Pediatric Health Information System (PHIS) data by dates of birth and transplant, center and sex. SPLIT data were used to identify LT recipients (2011-2016) with BS. Procedure and admissions costs from PHIS were inflation-adjusted to 2022. Sub-analyses evaluated costs associated with achieving OBO. Optimal biliary outcome was achieved in 42% of 77 participants following a median of 4 procedures and 2 inpatient nights compared to a median of 7 procedures and 4 nights in those without OBO (p < 0.001). BS management was lower in participants who achieved OBO versus who did not achieve OBO (p = 0.004). Significant center variation in cost was observed (p < 0.001). Biliary strictures diagnosed earlier post-PLT were associated with lower costs per patient (p = 0.049), while those who underwent surgical biliary revision did not incur higher costs per patient (p = 0.17). In participants who did not achieve OBO and underwent ≥ 6 PTC procedures tended to incur much higher costs compared to those who underwent ≤ 5 PTC procedures, regardless of surgical biliary revision (p = 0.08). Biliary stricture management costs were highest in patients requiring treatment for recurrence or surgical biliary revision and lowest earlier post-transplant, suggesting that more aggressive management upfront may optimize costs. Future work will explore practice variation and cost-effective strategies to achieve OBO.

Introduction: Evaluation of long-term results, risk factors for treatment failure, and complications in a contemporary cohort of patients with bulbar urethral strictures managed with direct vision internal urethrotomy (DVIU). Methods: We retrospectively reviewed 140 consecutive patients who underwent internal urethrotomy in a single institution between January 2012 and October 2020, with a minimum follow-up of 24 months. Most urethral strictures had an iatrogenic origin (89.3%), length under 2 cm (75%) and were located in the mid-bulbar urethra (56.4%). The main variable was treatment failure, defined as recurrent urethral stricture at the same location in urethrography or urethroscopy, or the need for dilation, internal urethrotomy or open urethral reconstruction. Secondary variables analyzed were length of stricture, suspected etiology, previous endoscopic procedures, hospital stay, days of catheterization, and postoperative complications such as infections or hematuria. Results: Treatment failure occurred in 61.4% of patients (104). Idiopathic strictures and those under 2 cm had better outcomes. Strictures longer than 2 cm and those with previous endoscopic procedures demonstrated a higher failure rate. More than 90% of recurrences occurred within the first 2 years of follow-up. Complications of DVIU were scarce with postoperative urinary tract infection/urosepsis in 5.7% and prolonged hematuria in 10%. The mean hospital stay was 2.9 days. Conclusion: DVIU is a safe and simple technique, with reasonable efficacy in primary cases of bulbar urethral strictures under 2 cm in length. Strictures longer than 2 cm or recurrent cases might be better approached through drug-coated balloon dilation or open urethral reconstruction. Follow-up after DVIU must be at least 24 months.

Anastomotic strictures are a common complication following esophagogastric surgery, with prevalence varying depending on the type of surgery and anatomical site. These strictures can lead to debilitating symptoms such as dysphagia, pain, and malabsorption, significantly impacting patients' quality of life. Endoscopic treatment of anastomotic strictures has established a role as the first-line strategy in this setting instead of revision surgery, offering benefits in terms of lower morbidity. Various endoscopic methods are available for anastomotic stricture management, including balloon dilation, stent placement, the new lumen-apposing metal stent, and endoscopic incision techniques. However, there is currently no strong evidence and established guidelines for the optimal treatment strategy. Available data suggest that endoscopic treatments, when performed in tertiary referral centers, can provide favorable outcomes in terms of symptom relief and reduced need for rescue surgical intervention. Nonetheless, challenges remain regarding the management of recurrent strictures and procedural complications, underscoring the need for a personalized, multidisciplinary approach to optimize clinical outcomes. This review aims to provide an updated overview of endoscopic techniques and available evidence with a focus on the most recent technologies, supporting clinicians in effectively managing anastomotic strictures in complex clinical settings.

Abstract Biliary strictures are a complicated entity that requires careful thought and dedicated workup to define, understand, and plan the proper management pathway. From a surgical standpoint, it can be a mixed bag at the time of presentation. Even then, the information may not be fully diagnostic and often requires multiple interventions to assess the pathology and extent of the disease. In most cases, there is concern for malignancy with no effective screening tools and small surgical windows for cure. Therefore, a dedicated multidisciplinary team of surgeons, interventional radiologists, advanced endoscopists, hepatologists, and oncologists is always necessary to work together efficiently to gather information, diagnose, prevent secondary complications, and create an effective treatment plan with aligned goals of care.

To evaluate long-term urethral patency of short bulbar urethral stricture management using visual internal urethrotomy with platelet-rich plasma (PRP) in conjunction with dexamethasone injection. This retrospective study included 78 male patients with symptomatic short bulbar urethral stricture (diagnosed by ascending urethrography) who were treated by internal urethrotomy after injection of submucosal PRP combined with dexamethasone. Every patient was monitored for urethral stricture recurrence one month after catheter removal and twenty-four months after internal urethrotomy. The etiology of urethral stricture was iatrogenic in 63 (80.8%) patients, inflammatory in 9 (11.5%) patients, and idiopathic in 6 (7.7%) patients. In terms of complications, two patients (2.7%) experienced bleeding per urethra, four patients (5.4%) had fever, three patients (4%) had hematuria, one patient (1.4%) had perineal abscess, and seven patients (9.5%) had a recurrence of stricture. The etiology of the stricture did not have any significance in patients who experienced recurrence (P = 0.77). Our findings suggest a potential protective effect of PRP and dexamethasone injection at the time of internal urethrotomy also decreased the length of stricture in case of recurrence. This protective effect lasted for at least 2years.

380 DNA/RNA-Based Next-Generation Sequencing (NGS) Improves the Early Diagnosis and Management of Malignant Bile Duct Strictures: A Five-Year, Prospective, Multi-Institutional Study

V140 – Management of post-ureteroscopy ureteral strictures: Analysis of endoscopic treatment and reconstructive surgery

AB001. SOH25_AB_049. Management of bulbar strictures in boys following previous endoscopic treatment of posterior urethral valves

Small bowel strictures secondary to either benign or malignant causes are associated with significant morbidity and impaired quality of life. Symptoms and their severity are dependent on the location and the degree of stenosis which, in addition to the etiology, dictate the approach to treatment. Endoscopic management of small bowel strictures include endoscopic balloon dilation, enteral stenting, endoscopic ultrasound-guided gastroenterostomy (EUS-GE), and stricturotomy. The introduction of the cautery-enhanced lumen-apposing metal stent has streamlined EUS-GE and has brought it to the forefront especially for select patients with malignant gastric outlet obstruction (GOO) with acceptable survival. This review will summarize the literature regarding the aforementioned interventions and will focus on EUS-GE and how it compares with traditional use of enteral stents and surgical gastrojejunostomy in the management of malignant GOO.

Introduction: Lumen-apposing metal stents (LAMS) were initially developed for the endoscopic management of pancreatic fluid collections; however, numerous off-label uses have been utilized, including management of anastomotic strictures (1–4). Limited data exist for its efficacy in lower gastrointestinal strictures, and its utility is limited by the ability of the gastroscope to reach the area of stricture. Small retrospective studies and case reports have shown clinical success rates upward of 85% in managing colonic anastomotic strictures (5). In this video case report, we describe our technique for the use of a LAMS for the management of a high-grade ileocolic anastomotic stricture.

A0911 – Comparative outcomes of ureter-ileum interposition vs. autologous urinary tract reconstruction in the management of proximal ureteral strictures: A retrospective study

P353 – The value of reconstructive surgeon in urology departments: Enhancing decision-making for urethral stricture management

Tumours or strictures compressing the trachea /bronchial tree cause central airway obstruction (CAO). Subglottic stenosis are a cause of respiratory symptoms and distress. Idiopathic sub glottic stenosis (ISGS) is a rare disease occurring mainly in women and has a history of recurrences. Endoscopic laser microsurgery and balloon dilatation are used in the management of strictures. Recurring strictures may require tracheoplasty. Poly chondrites is a rare disorder causing poly arthritis and inflammation of cartilaginous tissue. Inflammatory changes in the lung cause tracheobronchomalacia (TBM) and lung collapse. Relapsing polychondritis (RP) effecting the airway is life threatening as there is dynamic airway closure during expiration. The medical therapy in RP includes steroids, disease modifying agents ( methotrexate) and biologics. Surgical interventions include tracheostomies and tracheobronchial stents for severe forms of the illness.

Objectives: To evaluate the efficacy of Intra-lesional triamcinolone injection in the management of refractory benign esophageal Stricture in children. Methods: Before endoscopic dilatation, triamcinolone acetate (40 mg/ml) was be applied in the first 5 dilations with an interval of one week between the first and second dilation and then every 2 weeks. Results: A total of 67 children with refractory benign esophageal stricture out of 183 children (36.6%) who presented with esophageal stricture were enrolled in the study, Cause of esophageal stricture was post-corrosive injury (n=59, 88.1%), with a smaller proportion attributed to post-TEF repair (n=8, 11.9%), There was a significant reduction in the number of dilatations required before and after the triamcinolone injections. The mean maximum dilation improved from 10.66 mm SG(Savary-Gilliard) before injections to 13.13 mm SG after injections, periodic dilatation index (PDI) showed significant reduction post-treatment. The mean PDI decreased from 1.07 to 0.27, There was a significant improvement in the grades of dysphagia, there was no significant changes in cortisone levels, ACTH (Adrenocorticotropic hormone) levels showed no significant change, there were no major complications of the procedure. Conclusion: findings suggest that intralesional triamcinolone injection is an effective and safe treatment option for refractory benign esophageal strictures in children.

Abstract Biliary strictures can occur due to benign and malignant etiologies, of which ∼30% are due to benign causes. The diagnosis of benign biliary strictures (BBSs) is often missed or delayed as many cases present with subtle clinical findings. Clinical presentation in these patients is often variable ranging from asymptomatic to cholangitis and sepsis. Diagnosis can be done using various modalities like ultrasound, computed tomography, and magnetic resonance imaging. Imaging helps identify the stricture location, extent as well as etiology of obstruction. Management of BBS requires a multidisciplinary approach of surgeon, gastroenterologist, and interventional radiologist. The percutaneous approach provides an alternative to surgery or endoscopic-guided procedures in biliary stricture treatment with the main advantages being rapid decompression of the biliary system and prompt relief of cholangitis. This review provides an overview of various percutaneous management techniques by interventional radiologists. The various percutaneous techniques like percutaneous transhepatic biliary drainage, balloon dilatation, plastic or biodegradable stents, magnetic compression anastomosis, and percutaneous endobiliary radiofrequency ablation are discussed.

Abstract Biliary strictures are a relatively rare condition characterized by narrowing of the intrahepatic or extrahepatic bile ducts. Though biliary strictures are most commonly malignant in etiology, both benign and malignant strictures are associated with significant morbidity and mortality. The diagnosis of an indeterminate biliary stricture is often challenging and requires a comprehensive workup, including laboratory testing, biochemical markers, and imaging and endoscopy, with the primary aims of differentiating malignant versus benign biliary disease and identifying the location, length, and extent of the stricture. A wide range of imaging modalities can be employed in doing so, including ultrasound, computed tomography, magnetic resonance imaging, or magnetic resonance cholangiopancreatography. Tissue sampling is often required during the workup of indeterminate biliary strictures and is most feasibly obtained through endoscopy. Diagnosis of indeterminant biliary strictures should be prompt to prevent long-term sequelae of the disease. Once diagnosed, the treatment of biliary strictures is guided by the etiology, location, and severity of the stricture. Benign biliary strictures have been historically treated with balloon dilation and stenting. These procedures remain mainstays in treatment, but additional therapeutic advances including radiofrequency ablation, laser stricturotomy, and magnetic compression anastomoses have emerged as novel, potentially beneficial adjuncts. In malignant biliary strictures, the resectability of malignancy is the primary factor determining treatment. Surgical management for resectable malignancies causing malignant biliary strictures remains the gold standard treatment approach. For unresectable malignant biliary strictures, the goal shifts to adequately draining the biliary tree to palliate the patient using similar treatment approaches as benign biliary strictures. With advancing endoscopic, percutaneous, and surgical techniques, standard-of-care diagnostic and treatment approaches are likely to continue to evolve to further optimize long-term outcomes.

Although fully covered self-expandable metal stents (FCSEMS) are used for the management of anastomotic biliary stricture (ABS) after liver transplantation (LT), there is concern about long-term adverse events such as recurrence of stricture. We evaluated the long-term efficacy of a modified nonflared FCSEMS (M-FCSEMS) compared to plastic stents (PS) for refractory ABS after LT. Consecutive patients who underwent placement of an M-FCSEMS (M-FCSEMS group) or multiple PS (PS group) for refractory ABS after LT were enrolled. The primary outcome was the stricture recurrence rate, and the secondary outcomes were technical success, clinical success, and the rate of de novo stricture. In both groups, technical success was achieved in all patients. The median stent duration was 3.1 months in the M-FCSEMS group and 7.6 months in the PS group (P < 0.001). Clinical success rates were 96.7% (29/30) for the M-FCSEMS group and 94.4% (17/18) for the PS group (P = 0.709). Stent migration occurred in 10.0% (3/30) of the patients before removal of the stent in the M-FCSEMS group, while 27.8% (5/18) of patients in the PS group showed stent migration (P = 0.110). Stricture recurrence occurred in 17.2% (5/29) in the M-FCSEMS group, compared to 47.1% (8/17) in the PS group (P = 0.036). There were no de novo strictures observed in either cohort. Modified nonflared FCSEMS is effective for relieving refractory ABS after LT, with a low recurrence rate and the absence of de novo stricture after long-term follow-up.