Gut Liver.
2011 Sep;5(3):328-334.
Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Patients with Post-Liver Transplant Biliary Complications: Results of a Cohort Study with Long-Term Follow-Up
- Affiliations
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- 1Department of Gastroenterology, University of Turin, Molinette Hospital, Turin, Italy. g.saracco@tin.it
- 2Liver Transplantation Center, University of Turin, Molinette Hospital, Turin, Italy.
- 3Gastroenterology Unit, Maria Vittoria Hospital, Turin, Italy.
- 4Gastroenterology Unit, S. Giovanni Bosco Hospital, Turin, Italy.
- 5Gastroenterology Unit, Humanitas Hospital, Rozzano (MI), Italy.
- 6Unit of Cancer Epidemiology, University of Turin, Molinette Hospital and CPO Piemonte, Turin, Italy.
Abstract
- BACKGROUND/AIMS
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients.
METHODS
The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years).
RESULTS
Of the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34).
CONCLUSIONS
ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.
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