Prospective study of hepatobiliary scintigraphy and endoscopic cholangiography for the detection of early biliary complications after orthotopic liver transplantation.
BACKGROUND
Biliary complications are a significant cause of morbidity and death after orthotopic liver transplantation (OLT). This study was a prospective evaluation of endoscopic retrograde cholangiography (ERC) and hepatobiliary scintigraphy (HBS), using 99mTc Mebrofenin, to detect early biliary complications following OLT.


METHODS
One hundred consecutive patients who had OLT with a biliary duct-to-duct anastomosis were studied. Of these, 67 had both ERC and HBS performed within 30 days of OLT. Sensitivity, specificity and diagnostic accuracy of HBS in identifying biliary leak or stricture was calculated.


RESULTS
Of the 67 cholangiographies performed 45 were normal. In 22 patients there was radiological evidence of a leak (n = 14) or stricture (n = 8) which required further intervention in nine and four patients respectively. The sensitivity and specificity of scintigraphy for the detection of biliary leak after transplantation was 50 and 79 per cent and for biliary stricture 62 and 64 per cent respectively. No patient with normal scintigraphy required biliary intervention. Only six of 14 patients with biliary leaks and two of 20 with strictures suggested by scintigraphy required intervention. If both ERC and HBS reported leak or stricture, the intervention rate was considerably higher at five of seven leaks and two of five strictures.


CONCLUSIONS
This study suggests that scintigraphy is a useful screening test for biliary complications after OLT, ERC is only necessary if HBS is abnormal.
Kurzawinski
T R
TR
Hepatobiliary and Liver Transplant Unit, Royal Free Hospital and School of Medicine, London, UK.
Selves
L
L
Farouk
M
M
Dooley
J
J
Hilson
A
A
Buscombe
J R
JR
Burroughs
A
A
Rolles
K
K
Davidson
B R
BR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging*; D002648:Child; D002758:Cholangiography / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; C034837:technetium Tc 99m mebrofenin; D005998:Glycine