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


OBJECTIVE
To determine the role of ERCP in the diagnosis and treatment of patients who have undergone hematopoietic stem cell transplant and the patients' clinical outcomes.


METHODS
Retrospective analysis of patients with hematopoietic stem cell transplant who underwent ERCP from 1997 to 2004 evaluating ERCP indications, diagnosis, therapeutic interventions, and complications.


METHODS
Tertiary referral center.


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 of 16 patients, bile duct leak in 1 of 16, pancreatic duct stone in 1 of 16, and normal ERCP in 1 of 16. 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.


CONCLUSIONS
Single-center study.


CONCLUSIONS
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.
Division of Gastroenterology and Hepatology, University of Iowa Hospital and Clinic, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Majed M
MM
Alnusair
Margarida
M
DeMagalhaes-Silverman
William B
WB
Silverman
D000293:Adolescent; D000328:Adult; D017734:Bile Ducts, Extrahepatic / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000175:diagnosis* / Q000209:etiology; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000209:etiology; D010183:Pancreatic Ducts / Q000473:pathology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors