Endoscopic treatment of bile duct complications after orthotopic liver transplantation.
OBJECTIVE
To assess the indications and results of endoscopic retrograde cholangio-pancreatography (ERCP) in patients who have undergone ortotopic liver transplantation (OLT).


METHODS
We reviewed data from 42 consecutive patients who underwent ERCP for biliary complications after OLT over an 8-year period, in particular recording indications and success of the treatment after a mean of 17 months follow-up.


RESULTS
Cholangiograms performed in 33/42 patients (79%) displayed anastomotic strictures in 17 patients (52%), bile duct stones in 8 (24%), both bile duct stones and an anastomotic stricture in 2 (6%), papillary stenosis in 1 (3%), and anastomotic biliary leakage in 1 (3%). In contrast, the contrastogram was normal in four patients (12%). Stone extraction was completed in 9/10 patients (90%) with a mean of 1.2 sessions, while stricture dilation was achieved in 12/19 patients (63%) after a mean of 1.7 sessions, by stent positioning (n = 7), balloon dilation (n = 4), or Soehendra dilator (n = 1). Both biliary leakage and papillary stenosis were cured by ERCP. Only one procedure-related complication -- severe pancreatitis (2.4%) -- was observed and no mortality.


CONCLUSIONS
ERCP is a safe and effective mode of management of bile duct complications after OLT. It should be attempted before a surgical approach. Better results are obtained for treatment of biliary stones than of anastomotic strictures.
Polese
L
L
Department of Surgical and Gastroenterological Sciences, 1st Surgical Clinic, Surgical Endoscopy Unit, Padova University, Padova, Italy.
Cillo
U
U
Brolese
A
A
Boccagni
P
P
Neri
D
D
Bassi
D
D
Erroi
F
F
Zanus
G
G
D'Amico
D F
DF
Norberto
L
L
D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000139:chemically induced* / Q000601:surgery / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005704:Gallbladder / Q000601:surgery; D042882:Gallstones / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies