The role of ERCP in patients with pancreatico-biliary problems in the setting of hematopoietic stem cell transplant

• Published in: Gastrointestinal endoscopy 2006-04, Vol.63 (4), p.655-659
• Main Authors: Alnusair, Majed M., MD, deMagalhaes-Silverman, Margarida, MD, Silverman, William B., MD, FACG
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bile Ducts, Extrahepatic - pathology; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis - diagnosis; Cholelithiasis - etiology; Cholestasis, Extrahepatic - diagnosis; Cholestasis, Extrahepatic - etiology; Digestive system; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Hematologic Neoplasms - surgery; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pancreatic Diseases - diagnosis; Pancreatic Diseases - etiology; Pancreatic Ducts - pathology; Postoperative Complications; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Risk Factors
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2005.12.033

Background Patients undergoing hematopoietic stem cell transplant may develop pancreatico-biliary complications that may require ERCP. Due to their immunocompromised state, these patients may be at higher risk of procedure-related complications. Aim To determine both the role of ERCP in the diagnosis and treatment of patients who have undergone hematopoietic stem cell transplant and the patients' clinical outcomes. Materials and methods Retrospective analysis of hematopoietic stem cell transplant patients who underwent ERCP from 1997 to 2004 to evaluate ERCP indications, diagnosis, therapeutic interventions, and complications. Results Of the 16 patients identified, 9 were female, 15 had had allogeneic hematopoietic stem cell transplant, and 1 had an autologous hematopoietic stem cell transplant. Twenty-six ERCP procedures were performed in the 16 patients. Index ERCP findings included extra hepatic bile duct obstruction in 12 patients, of which 7 had biliary lithiasis. Ampullary obstruction due to infiltration from graft-versus-host disease was seen in 3 of 12 patients, benign bile duct stricture in 1 of 12, and ampullary obstruction in the setting of a peri-ampullary diverticulum in 1 of 12. Index ERCP findings in the remaining 4 patients included intrahepatic bile duct compression due to metastatic disease in 1 patient, bile duct leak in 1 patient, pancreatic duct stone in 1 patient, and normal ERCP in 1 patient. Complications occurred in 4 patients: mild pancreatitis (1), mild bleeding (1), cholangitis due to late stent occlusion (1), and intermittent bradycardia (1). There were no ERCP related deaths. Conclusion In patients with hematopoietic stem cell transplant, bile duct lithiasis was the most common finding at ERCP, followed by obstructive ampullary tissue infiltration due to graft-versus-host disease. ERCP yielded clinically relevant information in this particular group of patients.