Endoscopic management of biliary complications following orthotopic liver transplantation

W. F. Jones, R. Kaikaus, L. Deeb, M. Coffey, C. Tamburro, R. Bentley, J. Jones, S. Mizrahi, M. Heck

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INTRO: Biliary complications following orthotopic liver transplantation (OLT) have been reported in up to 1/3 of cases. Endoscopic retrograde cholangiopan-creatography (ERCP) can be used to identify and treat both early and late biliary complications and assist in the diagnosis of cholestasis when the etiology cannot be adequately assessed noninvasively. METHODS: From 5/90 to 6/97, 141 OLTs were performed. 35 post-OLT pts (34/35 duct-to-duct anastomosis) underwent 100 ERCPs. Indications for initial ERCP included abnormal liver function tests (LFT's) (n = 17), clinical or biopsy proven cholangitis (n = 6), bile leaks (n = 6), radiographic biliary obstruction (n = 2), and miscellaneous (n = 4). Time from OLT to initial ERCP was 1-7d (n = 5), 8-28d (n = 13), 29-365d (n = 11), and >365d (n = 6). Multiple ERCPs were performed in 24 pts (range 2-8, mean 3.6) for management of strictures (STX) and leaks. Diagnoses at initial ERCP included normal (n = 9), high/low grade anastomotic STX (n = 25), non-anastomotic STX (n = 3), bile leak (n = 5) pancreatic duct leak (n = 1), sump syndrome (n = 1) and miscellaneous (n = 2). In 2/35 pts, common bile duct cannulation was initially unsuccessful (5.7%). 100 ERCPs included the following interventions: endoscopic sphincterotomy (n = 27), dilatation (n - 19), stents (n = 43), nasobiliary tube (n = 2). Procedure associated complications consisted of desaturation requiring reversal agents (n = 1), cholangitis complicating indwelling stents (n = 3), pancreatitis (n = 1) and stent migration requiring replacement (n = 4) for an overall rate of 9%. Successful endoscopic therapy for leaks and STX was defined cholangiographically. RESULTS: 5/28 pts with STX died of nonbiliary causes. 15/28 had data available for evaluation and FU>6m. 11/12 had successful resolution of anastomotic STX; 1/12 required surgical revision. 2/3 with intrahepatic duct STX did not resolve. Successful endoscopic treatment of anastomotic stricture vs. intrahepatic stricture (p = .0813 Chi square). Mean time to STX resolution was 35 wks (range 4-87). Mean number of ERCPs to resolve STX was 4 (range 2-8). Successfully treated STX are presumed patent at mean FU of 50 wks (range 10-149). 2/5 pts with biliary leaks failed endoscopic therapy and required surgical correction (1<7d, 1>100d). Biliary leaks required an average of 2 ERCPs and a mean of 4.6 wks to resolution. CONCLUSIONS: ERCP is safe and effective in post OLT patients. Standard imaging tests frequently fail to diagnose biliary tract complications. Both leaks and strictures, particularly anastomotic, can be treated successfully with standard therapeutic endoscopic modalities.

Original languageEnglish
Pages (from-to)AB118
JournalGastrointestinal Endoscopy
Issue number4
StatePublished - 1 Dec 1998
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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