Elsevier

Transplantation Proceedings

Volume 39, Issue 6, July–August 2007, Pages 1942-1944
Transplantation Proceedings

Liver
Complication
Endoscopic Treatment of Bile Duct Complications After Orthotopic Liver Transplantation

https://doi.org/10.1016/j.transproceed.2007.05.053Get rights and content

Abstract

Aim

To assess the indications and results of endoscopic retrograde cholangio-pancreatography (ERCP) in patients who have undergone ortotopic liver transplantation (OLT).

Methods

We reviewed data from 42 consecutive patients who underwent ERCP for biliary complications after OLT over an 8-year period, in particular recording indications and success of the treatment after a mean of 17 months follow-up.

Results

Cholangiograms performed in 33/42 patients (79%) displayed anastomotic strictures in 17 patients (52%), bile duct stones in 8 (24%), both bile duct stones and an anastomotic stricture in 2 (6%), papillary stenosis in 1 (3%), and anastomotic biliary leakage in 1 (3%). In contrast, the contrastogram was normal in four patients (12%). Stone extraction was completed in 9/10 patients (90%) with a mean of 1.2 sessions, while stricture dilation was achieved in 12/19 patients (63%) after a mean of 1.7 sessions, by stent positioning (n = 7), balloon dilation (n = 4), or Soehendra dilator (n = 1). Both biliary leakage and papillary stenosis were cured by ERCP. Only one procedure-related complication—severe pancreatitis (2.4%)—was observed and no mortality.

Conclusion

ERCP is a safe and effective mode of management of bile duct complications after OLT. It should be attempted before a surgical approach. Better results are obtained for treatment of biliary stones than of anastomotic strictures.

Section snippets

Patients

In this retrospective study, we reviewed the data on all consecutive patients who underwent endoscopic treatment of biliary duct lesions after liver transplantation between 1998 and 2006. Orthotopic liver transplantation (OLT) recipients who underwent at least one ERCP were identified through an endoscopic computerized database. Indications, findings, and interventions performed during the exam were noted for each patient from the ERCP report. All other data, including the outcome of the

Results

Forty-two patients (mean age 50 years, range 13 to 65 years) underwent 58 ERCP (mean 1.38 sessions per patient) for biliary duct complications at a mean of 29 months after liver transplantation (range 0 to 133 months). Indications for ERCP were suspicion of bile duct stricture in 31, of bile duct stones in nine, or of bile leakage in two.

Papilla cannulation was possible in all but two patients (5%) who developed a spastic papilla. After entering the papilla, the choledochus was injected with

Discussion

Biliary duct lesions are the leading cause of surgical complications after liver transplantation, requiring in some cases biliary reconstruction by choledocho-choledocostomy or HJ.2 The diagnosis and treatment of these complications is performed more frequently by nonoperative approaches, than in the past namely percutaneous transhepatic cholangiography and ERCP. According to the results of this study, ERCP was a safe treatment modality, with a low risk of complications (2.4%) and an absence of

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