Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation.
BACKGROUND
We report our current experience using endoscopic retrograde cholangiography in the management of post-transplantation biliary tract complications.


METHODS
Twenty-three patients among 109 adult liver transplant recipients underwent retrograde cholangiography because of cholestasis (18 patients) or bile leaks (5 patients).


RESULTS
Eleven of 18 patients developed anastomotic strictures, all successfully dilated by plastic stents; one patient required Roux-en-Y revision due to recurrent cholangitis while stented. Three had biliary calculi extracted following sphincterotomy. Two developed intrahepatic ductal strictures secondary to severe rejection. One patient had hepatic artery thrombosis with a hilar stricture. One cholangiogram was normal. Three patients developed bile peritonitis following T-tube removal, all treated by sphincterotomy and nasobiliary drainage. Choledochal perforation resulting from an impacted T-tube limb was detected in two patients, both treated with sphincterotomy and nasobiliary drainage.


CONCLUSIONS
Strictures within 3 months of surgery required 3 months of stenting; those occurring later required longer periods of time to respond. Bile leaks responded uniformly and rapidly to drainage. Endoscopic retrograde cholangiography is a useful diagnostic and therapeutic intervention for post-transplantation biliary tract complications.
Bourgeois
N
N
Service Medico-Chirurgical de Gastroenterologie et d'Hepato-Pancreatologie, Université Libre de Bruxelles, Belgique.
Deviére
J
J
Yeaton
P
P
Bourgeois
F
F
Adler
M
M
Van De Stadt
J
J
Gelin
M
M
Cremer
M
M
D000328:Adult; D001652:Bile Ducts / Q000473:pathology; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002758:Cholangiography / Q000379:methods; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016145:Endoscopy, Digestive System; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome