Endoscopic Treatment of Bile Duct Complications After Orthotopic Liver Transplantation

• Published in: Transplantation proceedings 2007-07, Vol.39 (6), p.1942-1944
• Main Authors: Polese, L, Cillo, U, Brolese, A, Boccagni, P, Neri, D, Bassi, D, Erroi, F, Zanus, G, D’Amico, D.F, Norberto, L
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical; Bile Duct Diseases - chemically induced; Bile Duct Diseases - surgery; Bile Duct Diseases - therapy; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gallbladder - surgery; Gallstones - surgery; Humans; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Reconstructive Surgical Procedures; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2007.05.053

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.